RESEARCH PROPOSAL

SUBMITTED TO SUBMITTED BY

Mrs. A. Sunitha madam A. Malleshwari

lecturer M.sc(N) 1ST year Govt

college of nursing, Govt college of nursing,
somajiguda somajiguda

SUBMITTED ON:27/06/2020
 INTRODUCTION 

“The liquid you see may not seem like much to most, but for
millions of children it is a life-saving drug, Insulin is not a cure;
it keeps them alive until a cure is found”. 1 

- Canadian discovery 

 
Juvenile diabetes also called as type -1 Diabetes Mellitus (DM) Type 1 is a chronic

metabolic disorder, characterized by a partial or complete deficiency of insulin hormone insulin

production, resulting from the destruction of pancreatic beta cells, usually caused by the autoimmune or

idiopathic process. Permanent neonatal Diabetes is caused by glucokinase deficiency, and is an inborn

error of the glucose-insulin signalling pathway. It can occur in a quick and progressive way in children

and adolescents. Type 1 Diabetes (T1D) is one of the most common chronic diseases in children. The

exact number of patients with Type 1 Diabetes around the world is unknown, but it seems that the

annual prevalence is raising globally and the World Health Organization (2013) has predicted that by

2030 the number of adults and children with Diabetes Mellitus would have almost doubled worldwide,

from 177 million in 2000 to 370 million.

There are two main Types of Diabetes Mellitus:

i. Type 1 Diabetes Mellitus, also called Insulin Dependent

Diabetes Mellitus (IDDM), is caused by lack of insulin secretion by beta

cells of the pancreas.

ii. Type 2 Diabetes Mellitus, also called Non-Insulin Dependent

Diabetes Mellitus (NIDDM), is caused by decreased sensitivity of target

tissues to insulin. In both Types of Diabetes Mellitus, metabolism of all the main foodstuffs is altered.

The basic effect of insulin lack or insulin resistance on glucose metabolism is to prevent the efficient

uptake and utilization of glucose by most cells of the body, except those of the brain (Guyton and Hall,
2006).6 As a result of this, blood glucose concentration increases, cell utilization of glucose falls

increasingly lower and utilization of fats and proteins increases.

According to the Diabetes Atlas 2015 published by the International Diabetes Federation, the

number of people with diabetes in India is currently around 69.2 million and is expected to rise to 123.5

million by 2040. Type 1 diabetes mellitus (T1DM) is one of the most common pediatric endocrine

illnesses. India is estimated to be home to about 97,700 children with T1DM.  Data collected from

hospital-based studies in 1990 from India suggest that young diabetics (onset of diabetes before the age

of 15 years) constitute about one percent to four percent of the total diabetic population. India had

reported a prevalence of juvenile diabetes (onset below 15 years) less than one percent to 3.61percent

between 1964 and 1989. In 2006 the ICMR established the Registry of People with Diabetes with

Young Age at Onset (YDR) in 2006 to probe into the history of diabetes in the young in India. In phase

1, the registry enrolled 5546 patients, in which type 1 diabetes mellitus (T1DM) was the most prevalent

(63.9 percent), followed by youth-onset type 2 diabetes mellitus (T2DM) (25.3 percent).

Type 1 Diabetes Mellitus represents around 10% of all cases of Diabetes, affecting

approximately 20 million people worldwide (American Diabetes Association, 2010).Although Type 1

Diabetes affects all age groups, the majority of individuals are diagnosed either at around the age of 4 to

5 years, or in their teens and early adulthood (Blood et al., 1975)

. incidence of Type 1 Diabetes Mellitus is increasing across Europe, the average annual

increase in the incidence in children under 15 years is 3.4 With the steepest rise in those under 5 years

old (Karvonen et al.1999). Type 1 Diabetes Mellitus is the result of an autoimmune reaction to proteins

of the islets cells of the pancreas (Holt, 2004).There is a strong association between Insulin Dependent

Diabetes Mellitus and other endocrine autoimmunity (for example, Addison disease) and an increased

incidence of autoimmune diseases are seen in family members of Insulin Dependent Diabetes Mellitus

patients.

PATHOGENESIS OF TYPE 1 DIABETES MELLITUS:

Type 1 Diabetes Mellitus is a chronic autoimmune disease associated with selective destruction of

insulin-producing pancreatic β-cells. The onset of clinical disease represents the end stage of β-cell

destruction leading to Type 1 Diabetes Mellitus9

.ETIOLOGY OF TYPE 1 DIABETES:

 Obesity /overweight.

 Excess glucocorticoids.

 Excess growth hormone.

 Pregnancy -gestational Diabetes.

 Polycystic ovary disease.

 Autoantibodies to the insulin receptor.

 Mutations of insulin r-eceptor.

 Mutations of the peroxisome proliferators‟ activator receptor γ

(PPAR γ

 Mutations that cause genetic obesity (e.g., melanocortin receptor

mutations)

 Hemochromatosis (a hereditary disease that causes tissue iron

accumulation)10

.In several studies, it has been reported that the caring role, effectiveness and compassion of mothers are

more important than those of the other family members, and they are considered as the largest

group of family caregivers. Considerable changes in recent decades regarding the education

and employment of women as well as the expectation to take on complete maternal role have caused

mothers to assume more responsibility for caring their children. Also, other studies indicated that

controlling the metabolic condition of type 1 diabetes mellitus children has a close relationship

with the level of mother’s stress; the blood sugar of the children whose mothers had higher levels of

stress was less controlled. Hence, it is important that the healthcare providers support and guide them.
The difficulties associated with the available treatment regimens, including insulin injections, have pre-

occupied the mothers, and they wondered whether the use of new therapies was possible or would the

treatment become developed enough to cause less pain and distress to their children.

Awareness of the Diabetes complications and its impact on different aspects of

child health has caused these mothers to become anxious. In order to reduce the anxiety, nurses could

introduce new treatment methods and centres that provide services to the mothers of type 1 diabetes

mellitus children, to prevent unpredictable health status of diabetic children and the occurrence of acute

and critical conditions of their children suffering with Type 1 Diabetes Mellitus. The lack of free

healthcare services as well as inadequate insurance coverage for insulin and other therapeutic essentials

imposed a heavy financial burden on the families of children suffering from Diabetes Mellitus not with

standing the fact that more than 60% of Asians are covered by at least one type of health insurance.

The results of other studies have shown that the problems pertaining to insurance coverage and finances

related to the management of Diabetes were more dramatic in developing countries.

Since the reduction of these complications requires a careful management of

children, the nurses can help these mothers to make decisions about their daily affairs by empowering

and identifying their abilities as the first managers of their sick children, and provide training

programs tailored to the lifestyle of these mothers. Therefore, by creating family-centred care models,

nurses can pay attention to the needs of these mothers, in addition to managing their children’s

conditions. In another study, family-centred care and parents‟ participation and empowerment were

emphasized, and it was considered as one of the core concepts of paediatric nursing. They

believed this was necessary to maintain the family integrity as well as provide unique care.It is well

recognized that parents, in particular, the mothers of children with IDDM, confront with difficult tasks

such as coping with a regimen that includes administering insulin with strict and balanced diet and an

exercise plan. In addition, they have to deal with regular follow- up visits, with episodes of

hypoglycaemia, hyperglycaemia, and ketoacidosis, as well as with re-hospitalizations, when necessary.

Keeping the above approach, the present study attempted to further explore the contribution of mothers‟

psychological resources to the adjustment of their children with IDDM. Specifically, the contribution of

the relatively new concept of mothers' sense of empowerment to the adherence to treatment and

metabolic control of their children with Insulin Dependent Diabetes Mellitus.

NEED FOR STUDY

This study aimed to assess the effectiveness of Planned Teaching Program in enhancing practice and

psychological adaptation for mothers caring children with juvenile diabetes (or) Type 1 Diabetes

Mellitus.

PREVALENCE OF TYPE 1 DIABETES MELLITUS:

The greatest challenge faced by the modern world is Type 1 Diabetes Mellitus. It is expected that

approximately 366 million people will be affected by Type 1 Diabetes Mellitus by the year 2030.

The prevalence of Type 1 Diabetes Mellitus is increasing rapidly according to World

Health Organization (2013) has predicted that by 2030 the number of and children with Type 1 Diabetes

Mellitus would have almost doubled. Experts project that the incidence of Type 1 Diabetes Mellitus is

set to soar by 64% by 2025‚ meaning that a staggering 53.1 million citizens will be affected by this

disease.

According to W.H.O statistics, the global prevalence of Type 1 Diabetes Mellitus in the

year 2000 was 171,000,000 and it expected and approximated to be raised to 366,000,000 by 2030. 13

The estimated worldwide prevalence of Type 1 Diabetes Mellitus among children in 2010 was 285

million (6.4%) and this value is predicted to rise to around 439 million (7.7%) by 2030 (Shaw et al.,

2010).

The prevalence of Diabetes Mellitus in Asia has increased by 35% over the past seven

years. In Asia, it has been 15 years since the prevention and control of Diabetes have been formally

considered as the priorities of healthcare. Whereas its long arms have widely spread in India too, by the
statistical report of W.H.O, in the year 2000 the prevalence was 3,67,000 and expected to be raised to

6,35,000 by the year 2030 in India.

INDIAB study supported by the Indian Council of Medical Research indicate there are

about 42 lakh individuals with Type 1 Diabetes and 30 lakh people with Pre-Diabetes in Tamil Nadu.

V. Mohan, National co-ordinator of the INDIAB study, said the study shows the real burden of the

disease in the population. For the first time, a comprehensive picture of the national prevalence would

emerge, providing sufficient fodder for planners and health policy makers.

INSTITUTIONAL STATISTICS OF TYPE 1 DIABETES

YEAR OUTPATIENT CENSUS - INPATIENT CENSUS

2014 1514 37

2015 1805 41

2016 2094 72

2017 2119 87

According to the Diabetes Atlas 2015 published by the International Diabetes Federation, the

number of people with diabetes in India is currently around 69.2 million and is expected to

rise to 123.5 million by 2040. Type 1 diabetes mellitus (T1DM) is one of the most common

pediatric endocrine illnesses. India is estimated to be home to about 97,700 children with

T1DM.  Data collected from hospital-based studies in 1990 from India suggest that young

diabetics (onset of diabetes before the age of 15 years) constitute about one percent to four

percent of the total diabetic population. India had reported a prevalence of juvenile diabetes

(onset below 15 years) less than one percent to 3.61percent between 1964 and 1989. In 2006

the ICMR established the Registry of People with Diabetes with Young Age at Onset

(YDR) in 2006 to probe into the history of diabetes in the young in India. In phase 1, the

registry enrolled 5546 patients, in which type 1 diabetes mellitus (T1DM) was the most
prevalent (63.9 percent), followed by youth-onset type 2 diabetes mellitus (T2DM) (25.3

percent).

In India, maximum diabetes incidences were found in South India (13.5% in

Chennai, 16.6% in Hyderabad and 12.4%Bangalore) (Ramachandran et al., 2001), followed

by Eastern India (11.7% in Kolkata), Western India (9.3% in Mumbai), Northern India (6.1%

in Kashmir Valley, 11.6% in New Delhi) (Zargar etal., 2000). States of Northern India are

less affected (0.12 million diabetic cases in Chandigarh, 0.96 million diabetic cases in

Jharkand) (Anjana et al., 2011). The difference in diabetes incidences in different

geographical regions is due to migration. Populations of North India are migrants (non-

indigenous) whereas South Indian populations are host (indeginous) (Arora et al.2010).

Similarly, indigenous people from New Zealand and Australia were found to be more

diabetic than non-indigenous people (Bramley et al., 2004, Sukala et al., 2012). However

latest reports claim Sikkim state (13.67%) to have maximum percentage of diabetes

suspected followed by Karnataka (9.36%), Punjab (9.36%), Gujarat (9.10%) and Andhra

Pradesh (7.42%)

Review of literature and clinical experience made the investigator to realize the Type 1

Diabetes Mellitus is one of the major health problems worldwide. Home care management with proper

knowledge may reduce the risk of the illness to some extent. This motivates the investigator to

undertake a study on knowledge regarding home care management of Type 1 Diabetes Mellitus,

prevention and promotion of the health of the children through assessing mothers’ skills, provided to

their children (home care management methods: diet, exercise, insulin administration), the

psychological impact and burden of caring children with Type 1 Diabetes on mothers, implementing

planned teaching programme module to enhance mothers’ practice and adaptation.

PROBLEM STATEMENT

Effectiveness of planned teaching and demonstration on knowledge and

practice of mother regarding home care management of children with

juvenile diabetics at Nilofer hospital, Hyderabad, Telangana.

OBJECTIVES

 Assess the knowledge and practice of mother regarding home care

management of children with juvenile diabetics.

 Evaluate the effectiveness of planned teaching & demonstration on juvenile

diabetics.

 Association between demonstration on knowledge and practice of mother

regarding home care management of children with juvenile diabetics.

 Find the association between the knowledge and practice of mother

regarding home care management of children with juvenile diabetics.

OPERATIONAL DEFINITION

Effectiveness: It refers to the extent to which information, education and

communication module on juvenile diabetes has achieved the desired effect on the knowledge

and practice of mothers as evidenced by gain in knowledge

Planned Teaching: It is systematically well-planned teaching designed to provide

information to the mothers regarding home care management of children with juvenile

diabetics
Demonstration: It is a process of teaching someone how to make or do some
thing in a step by step process, action of insulin administration and its side
effects.

Knowledge and practice: It refer to the understanding about juvenile diabetes (or) Type

1 Diabetes Mellitus appropriate diet plan, administration of insulin injection technique,

personal hygiene, exercise and prevention of complications

Mothers: It refers to the person who is more important than those of the other family

members‟ giving total care to the child with juvenile diabetes

Juvenile diabetes: It is characterized by destruction of the pancreatic beta cells, which

produce insulin, this is usually leads to absolute insulin deficiency. Juvenile diabetes (or)

Type 1 diabetes has two forms: Immune mediated diabetes results from an autoimmune

destruction of the beta cells. Idiopathic type refers to rare forms of the disease that have no

known cause

CONCEPTUAL FRAMEWORK

Conceptual framework refers to interrelated concepts or abstractions that are assembled

together in some rational scheme by virtue of their relevance to a common theme

– (Polit and Hunger 1999)

General system theory was first introduced by Von Bertanlanffy (1968). He described that

general theory is a set of interrelated parts that come together to form a whole. Each part is a

necessary component required to make a complete meaningful whole.

The present study is based on open system theory of J.W.Kenney. It explains the following

concepts like structure, process and outcome.

A system consists of a set of interacting components, input(structure), throughput (process)

and output (outcome).Systems are organized into hierarchical level of complexity with sub-

system and super-system, subsystem may be single or complex system. Each system also has

a super-system.

The open system theory explains the relationship between the whole and the parts, a

description of concepts about them and prediction. An open system (knowledge) depends on

quality of its input (structure) throughput (process) and output (outcome).

INPUT

Input or structure specifies the designs to meet the global objectives. Input in this present

study refers to factors related to mothers of children with juvenile diabetic : sex of the child,

age of the child, religion, language, mother‟s education, occupation, family monthly income,

duration of the disease, family history of Diabetes Mellitus.Health care aspects of juvenile

diabetic regarding, disease condition, diet management, insulin administration, personal

hygiene ,exercise, play and prevention of complications.

THROUGHPUT

Throughput or process is refers to identifying the designs, interaction that place towards goal

achievement and regarding the activities. In this present study, throughput involves

assessment and intervention. Assessment envisages the area of knowledge of mothers of

children with juvenile diabetic. However, the focus of the study was to assess the knowledge.

Intervention includes learning process planned teaching programme. The focus of the study

was to assess the existing knowledge and practice of mothers of children with juvenile

diabetes regarding various aspects of juvenile diabetic children such general aspects about the

illness, investigation, identification of signs and symptoms, first line management methods

and prevention of complication.

OUTPUT

It is the return of matter, energy and information to the environment in the form of both

physical and psychological behavior.Output varies widely depending on the types and the

purpose of the system affecting the environment. Output or outcome refers to the end result

of the interaction between the input and throughput measured in terms of gain, loss and

changes that take place. It helps to measure the outcome of any intervention made regarding

knowledge and practice of mother’s regarding juvenile diabetic children.

ASSUMPTIONS

1) Mothers of children with juvenile diabetes have varying level of knowledge regarding

home care management and prevention of complications.

2) Planned teaching programme may help to improve knowledge of Mothers of children with

juvenile diabetes on home care management and prevention of complications.

HYPOTHESIS

H1: There is significant difference between pre-test and post-test knowledge score on

juvenile diabetes and its management after planned teaching programme among mothers of

children with juvenile diabetes.

H2: There is significant association between post-test knowledge score with selected

demographic variables regarding juvenile diabetes and its home care management among

mothers of children with juvenile diabetes.

DELIMITATIONS

 The study is limited to mothers with juvenile diabetes children in home care management

at Nilofer hospital, Hyderabad, Telangana.

 The study is limited to mothers with juvenile diabetic children up to 3 to 12 years

 The mothers who are willing to participate in the study

LITERATURE REVIEW RELATED TO THE

According to Polit and Hunger (1999) review of literature is a critical summary of research

on a topic of interest generally prepared to put a research problem on context or to identify

gaps and weakness on previous studies to justify a new investigation. A review of literature is

an extensive critical review of the research topic. It is an essential first step in those

methodologies that require context to interpret and understand the research problem by

locating it within the body of knowledge on the research topic.(Worralland caulley 1997) The

researcher came across with numerous theoretical and empirical literature related to the topic

under study.

The relevant and related literature that was found useful has been presented as

1) Studies related to incidence of Type 1 Diabetes Mellitus.

2) Studies related to knowledge of Type 1 Diabetes Mellitus.

3) Studies related to management of Type 1 Diabetes Mellitus.

4) Studies related to prevention of Type 1 Diabetes Mellitus.

1) STUDIES RELATED TO INCIDENCE OF TYPE 1 DIABETES

MELLITUS

Eliadarous H., et al (2017) conducted a comparative study on incidence of Type I Diabetes

in children aged 0 to 14 years from 2010 to 2014 with te previously reported figures in sudan.

All during below the age of 15 years diagnosed while living in Sudan, during the period were
identified from the registry. Tests for seasonal variation in incidence were carried out using

the method of walter and elwood. The median age at diagnosis for both sexes was 11 years

and there were slightly more girls than boys among the diabetic patients.

Raymond.N.T, et al, (2014) conducted a study to estimate and compare the incidence of

Type I Diabetes Mellitus in Leicestershire of children of South Asian and white or ethnic

backgrounds. All new cases of childhood onset Type I Diabetes Mellitus diagnosed before 15

years of age in Leicestershire. Ethnicity was assigned to all children in the study according to

their surnames.The convergence of rates for south Asians with other ethnic groups in

Leicestershire suggests that environmental factors are more important than genetic

predisposition in causing Type 1 Diabetes Mellitus in people of South Asian ethnic

background.

Terri H., et al., (2014conducted a study on risk factors for cardiovascular disease in children

with Type 1 Diabetes Mellitus in Philadelphia. Although an increased prevalence of lipid

abnormalities in many populations with Type 1 Diabetes Mellitus has been observed,

minimal data exist regarding the distribution, correlates the determinants of lipid levels of

children with Type 1 Diabetes Mellitus. This study was revealed that the lipid profile, the

links between cardiovascular disease, Type 1 Diabetes Mellitus and physiological risk factors

for cardiovascular disease in children with Type 1 Diabetes Mellitus.

STUDIES RELATED TO KNOWLEDGE OF TYPE 1 DIABETES

MELLITUS

Eray Ş, Uçar HN, et al (2016) conducted a descriptive study on the Relationship between

Perceived Family Climate and Glycemic Control in Type 1 Diabetes Mellitus adolescent

patients. The adolescents with Type 1 Diabetes Mellitus showed a significant difference

when compared with the control group. When diabetic adolescents were compared among
themselves, the diabetic adolescents with poor glycemic control perceived greater and less

emotional support. The study recommended that not only patients with psychopathology, but

all diabetic adolescents receive psychosocial support and family interventions.

Al-Odayani AN, Alsharqi OZ, (2016) conducted a a cross sectional study on

Children's glycaemic control and mother's knowledge and socioeconomic status at outpatient

clinics in prince sultan medical military city (PSMMC) Riyadh. The study illustrated that,

mothers with more knowledge of Type 1 Diabetes Mellitus and with better education were

maintaining a better glycaemic control of their children, irrespective of the socio-economic

status. It was found that, to improve glycaemic control and to decrease acute and chronic

complications of Diabetes Mellitus in children, mother's knowledge and education is needed.

Herman. W. et al (2016) conducted a qualitative descriptive study on children and young

adolescents voices perceptions of the costs and rewards of Diabetes and its treatment in New

York. Young people’s perception of the costs and rewards related to Diabetes may influence

their understanding of attitude toward and adherence to positive Diabetes related behaviours.

The results provide important insights in to the perception of children and young adolescents

with foster positive Diabetes related behaviours.

Freckleton E, Sharpe L, Mullan B,(2014) conducted a descriptive study on reasons for the

overly optimistic beliefs of parents of children with Type 1 Diabetes Mellitus and the

relationship between the beliefs and parental psychopathology. The results suggested that it is

usual and helpful for mothers of children with Diabetes to hold overly optimistic views about

their children's futures. Medical evidence appears to have little influence on mothers' beliefs

about likely outcomes for their children.

STUDIES RELATED TO MANAGEMENT OF TYPE 1 DIABETES

MELLITUS
Nakhla M, Rahme E.,et al., (2018) made a population-based retrospective cohort study on

risk of ketoacidosis in children at the time of Type 1 Diabetes Mellitus diagnosis by primary

caregiver status. The study identified 3704 new cases of Type 1 Diabetes in Quebec children

from 2006 to 2015. Of these, 996 (26.9%) presented with diabetic ketoacidosis. The

interpretation for children with newly diagnosed Type 1 Diabetes, having a usual provider of

care appears to be important in decreasing the risk of diabetic ketoacidosis at the time of

diagnosis. Study results provide further evidence concerning the need for initiatives that

promote access to primary care for children.

Tieu J, Middleton P, Crowther CA, Shepherd E, (2017) conducted a retrospective study

on Preconception care for diabetic women for improving maternal and infant health. Infants

born to mothers with pre-existing Type 1 or Type 2 Diabetes Mellitus are at greater risk of

congenital anomalies, perinatal mortality and significant morbidity in the short and long term.

Pregnant women with pre-existing Diabetes are at greater risk of perinatal morbidity and

diabetic complications. The relationship between glycemic control and health outcomes for

both mothers and infants indicates the potential for preconception care for these women to

be benefit.

Victor Florian, 1 PhD, and Dina Elad (2017) conducted a prospective study on the impact

of mothers' sense of empowerment of the metabolic control of their children with Type 1

Diabetes Mellitus. The mother's sense of empowerment expresses her attitude, knowledge,

and behavior within the context of her family in her dealings with her child, the service

system, and with her involvement in the community. The results also indicate that this special

psychological resource is relatively independent of the demographic characteristics measured

and only slightly related to the self-reported economic status. This result reflects the same
gender role identification or another psychological mechanism remains to be examined in

future studies.

Maryam Khandan,1 Farokh Abazari et al., (2016) conducted a study on lived experiences

of mothers with Diabetic children from the transfer of caring role. The findings of this study

revealed that after the confirmed diagnosis of Type 1 Diabetes Mellitus in children and their

discharge from the hospital, the mothers of these children experience several problems such

as „facing the care management challenge‟, „care in the shadow of concern‟, and „hard life

in the impasse of Diabetes‟.27

Shahbah D, El Naga AA, Hassan T (2016) conducted a study on Status of serum

magnesium in Egyptian children with Type 1 Diabetes Mellitus and its correlation to

glycemic control and lipid profile. Type 1 Diabetes Mellitus has been suggested to be the

most common metabolic disorder associated with magnesium deficiency, having 25% to 39%

prevalence. This deficit could be associated with the development of late diabetic

complications, especially macro-angiopathy. The study concluded that total serum

magnesium was frequently low in Egyptian children with Type 1 Diabetes Mellitus and it is

correlated with HbA1c and with lipid profile. Hypomagnesaemia was more evident in

patients with poor diabetic control and those with higher atherogenic lipid parameters.

Schoen S et al., (2016) conducted a DEDIPAC cross sectional survey on Diet Quality

during Infancy and Early Childhood in Children with and without Risk of Type 1

Diabetes.The quality of nutrient intake (PAN diet score) and food intake (analyzed by a

newly developed score) were assessed using three-day dietary records collected for at-risk

children (BABY diet study) and a matched sample of not-at-risk children (DONALD study)

at nine and 24 months of age. In at-risk children, dietary quality was similar between children

who were first exposed to gluten at six or 12 months of age. Despite being notified about
their child's risk of Type 1 Diabetes Mellitus, the child's mother did not switch to healthier

diets compared with not-at-risk mothers.

Grey.M, Keeble C, PA et al, (2015) conducted a retrospective analysis of data from

Learning Through Chain Event Graphs. The role of Maternal factors in childhood Type 1

Diabetes Mellitus, while incorporating mother's school-leaving-age and rhesus factor were

not associated with the Diabetes status of the child, whereas having at least 1 amniocentesis

procedure and, to a lesser extent, birth by cesarean delivery were associated; the combination

of both procedures further increased the probability of Diabetes.

Main A, Wiebe DJ, Van Bogart K et al (2015) conducted a prospective observational study

on secrecy from parents and type 1 diabetes mellitus management in late adolescence. This

study examined association of parent-adolescent relationship characteristics and adolescent

problem behavior with late adolescents secrecy from parents about Type 1 Diabetes mellitus

management, and whether secrecy was associated with Type 1 Diabetes Mellitus and

psychological outcomes independently of these factors. Adolescent reported disclosure to

parents was uniquely negatively associated with secrecy from parents. Controlling for

relationship variables, conduct problems, and socio demographic and illness-related

variables, secrecy from mothers was uniquely associated with poorer glycemic control and

secrecy from both parents was associated with lower adherence.

Pickup JC (2015) conducted a cross sectional study on economic evaluation of continuous

subcutaneous insulin infusion for children with Diabetes. The results were sensitive to

changes in glycated haemoglobin level. Improvements associated with glycaemic control led

to a reduced glycated haemoglobin level that could ensure good Type 1 Diabetes remains

unclear.
Nirmi .R., et al., (2015) conducted a study on insulin pump in youth with Type I Diabetes

mellitus a retrospective paired study to compare by age and glycemic control continuous

subcutaneous insulin infusion with multiple daily injections in youth with Type 1 Diabetes

mellitus. The data were compared between the 12 months of multiply daily injections that

preceded continuous subcutaneous insulin infusion and the period after the start of the whole

cohort and by the age group, the results a significant decrease in HbA1c was demonstrated

after the start of continuous subcutaneous insulin injection use for the entire cohort andfor the

prepubertal adolescent

Freckleton E, Sharpe L, Mullan B., (2014) The Environmental Determinants of Diabetes in

the Young (TEDDY) conducted a retrospective analysis on parental estimation of their child's

increased Type 1 Diabetes mellitus risk during the first 2 years of participation in an

International Observational Study. The analyses indicated that parental education, country of

residence, family history of Type 1 Diabetes Mellitus, household crowding, ethnic minority

status, and beliefs that the child's Type 1 Diabetes Mellitus risk can be reduced were factors

associated with parental risk perception accuracy. This is particularly true for fathers, families

from low socioeconomic backgrounds, and those with no family history of Type 1 Diabetes

Mellitus. It is important to develop improved tools for risk communication tailored to

individual family needs.

Chisholm V1, Atkinson L, (2014) conducted an exploratory study to investigate positive and

incongruent (i.e. the co-occurrence of contradictory verbal and non-verbal messages)

communication in the mother-child and their association with child adjustment and dietary

adherence outcomes. This study shows that specific features of dyadic, child and maternal

communication could be targeted in developmentally sensitive interventions to promote

positive communication in the home management of Type 1 Diabetes mellitus care for young

children.
Dashiff . J. et al., (2014) conducted study on to assess self-care of young adolescents with

Type I Diabetes Mellitus in Birmingham. Subject of this study were 152 adolescents aged

between 11 and 15 years with a diagnosis of Type I Diabetes Mellitus. Ethnicity and

adolescent sex were statistically significant in predicting deviation self – care. Health

deviation self-care decreases with age, suggesting that early adolescence or late school age is

an appropriate time for intervention to strength self-care behaviours.

Sparud-Lundin C, Hallström I, Erlandsson LK, (2013) study by constant comparative

analysis method, explores parents process of changes and challenges in their patterns of daily

activities after the onset of Type 1 Diabetes in their children and how personal gender

relations can restrain or create functional strategies for managing the changes and challenges

of illness, the core category depicts how the illness forced parents to reconstruct their family

project with respect to patterns of daily activities and gender structures. With increased

knowledge of the dynamics of gender relations of families in the context of a children illness,

health care professionals can assist in promoting well-being and functional strategies in

families when a child is newly diagnosed with Type 1 Diabetes Mellitus.

Florian.V.et al., (2013) conducted a study on the impact of mothers

sense of empowerment as a psychological resource and the level of adherence to treatment

and metabolic control of their adolescent children with Insulin Dependent Diabetes Mellitus.

Barilan University their children with insulin dependent Diabetes Mellitus filled out theself-

care behaviors of the mothers sense of empowerment contributes significantly to their

children‟s adherence to treatment.

Faulkner MS., et al., (2013) a study conducted to describe mothers perceptions of the

Diabetes related self-care abilities and practices of their school age children with Type 1

Diabetes Mellitus. The children were between the age of 11 to 12 and had been diagnosed
with Diabetes for minimum of 2 years. The study reveals that mothers reported that their

children with Type 1 Diabetes had learned skills in a predictable sequence were usually

motivated by events in the here and now and did not consistently perform all Diabetes related

skill of which they are capable. Most of the children were becoming embarrassed about

having Diabetes. There were considerable gender differences in the children‟s self-care

activities.

Pediatr.A.et al., (2013) The Aide to Juvenile Diabetes association,its role in the management

and education of patients with insulin- dependent Diabetes Mellitus in Paris. Aide to Juvenile

Diabetes association organizes three types of interventions.

i) stays in special summer camps provide children, teenagers and young adults with

the opportunity for receiving education in a recreational setting conducive to

acquisition of knowledge and behaviours required for the management of their

disease

ii) Continuing education through a news bulletin and information meetings improves

compliance to treatment.

iii) social and scientific interventions directly involve Aide to Juvenile Diabetes

association members and provide them with regular information. In conclusion, Aide to

Juvenile Diabetes association plays a central role in the management of Type I Diabetes

Mellitus in France.

Azar R Solomon C.R (2012) conducted study identified differences in strategies used by

mothers and fathers in coping with their children Insulin Dependent Diabetes Mellitus in

Canada. Results showed that both the parents used planned problem solving, exercised

positive re - appraisal, and sought social support frequently, with mothers using more planned

problem-solving strategies than fathers. Within the family analyses showed that fathers were
more likely to use frequently all the coping strategies when the child was a girl. The scores of

couples showed that mothers used all of the strategies significantly more often than fathers.

Dabelea D.et al., (2012) conducted study on the care of the children and adolescents with

Type 1 Diabetes Mellitus in Philadelphia. Reason cited for the rise of this condition in

children and adolescents are speculated to stem from obesity because of a rise in sedentary

behavior, non-nutritious food choices and genetic predisposition. A high recurrence rate in

families shows that therapy for children and adolescents must involve the entire family to be

successful. Treatment recommendations vary depending on severity but include nutrition,

exercise and medication. Assessment of the patients and families willingness to change their

current lifestyle behaviors is an integra l part of treatment. Nutrition and exercise goals

should be made on an individual basis to meet the needs of patient.

Anderson. B.J., Brackett.J.,Laffel. L.M (2010) a descriptive study with on education

effectiveness in Type 1 Diabetes Mellitus management made by children ́s caregivers at

brazil, The study reveals that the majority of caregivers of children with Type 1 Diabetes

Mellitus have good knowledge about the disease, and disease management and there is a need

to intervene in some ways, changing attitudes to cop more adequately with the disease, as

well as improving the effectiveness of Diabetes education

STUDIES RELATED TO PREVENTION OF TYPE 1 DIABETES

MELLITUS

Hansen UM, Olesen et al.,(2018) a descriptive study with quantitative approach on 1126

working people with Type 1 Diabetes Mellitus from a specialist Diabetes clinic in Denmark.

Diabetes-related emotional distress was assessed with the Problem areas in Diabetes scale

(PAID Scale-Problem Areas in Diabetes Questionnaire). The findings suggest that work-
related Diabetes distress captures an aspect of distress so far unaccounted for in workers with

Type Diabetes, and explore its clinical usefulness and clarify its risk factors.

Elbarbary NS, Ismail et al.,(2018) conducted a study on role of neopterin as a biochemical

marker for peripheral neuropathy in paediatric patients with Type 1 Diabetes Mellitus,

Relation to nerve conduction studies, Sixty patients aged ≤18 years and >5 years disease

duration were subjected to neurological assessment by neuropathy disability score for

median, ulnar, posterior tibial and common peripheral nerves. Neopterin levels were

positively correlated to motor latency of tibial and common peripheral nerves as well as

motor and sensory latencies of median and ulnar nerves. Neopterin cut off value 32nmol/L

could differentiate patients with and without Diabetic Peripheral Neuropathy with 100%

sensitivity and 96.7% specificity.

Adolfsson A, Dec 29 (2014) conducted a study protocol for it is a randomized controlled trail

on a web-based support study at Sweden. During pregnancy, in order to optimize the

probability of giving birth to a healthy child, their blood glucose levels need to be as normal

as possible. After childbirth, they experience a 'double stress': in addition to the ordinary

challenges they face as new mothers, they also need to focus on getting their blood glucose

levels normal. To improve self- management of Diabetes and overall well-being in women

with Type 1 Diabetes Mellitus to be used during pregnancy and early motherhood.

Sullivan S., et al., (2013) a study on constant vigilance descriptive naturalistic inquiry

principles were used to interview subjects. Mothers work parenting young children with Type

1 Diabetes Mellitus. The purposes of this study was to describe the day to day experiences of

mothers raising young children under 4 years of age with Type 1 Diabetes Mellitus. The rate

of severe hypoglycaemic episodes decreased significantly in the adolescent group, from 58.1
to 11.1 events per 100 patient years and in the young adult group, from 58.1 to 23.3. There

were no significant changes in the rate of Diabetes ketoacidosis between the 2 periods.

Quirk H. (2014) A qualitative study exploring parents’ perceptions of physical activity in

children with Type 1 Diabetes Mellitus. The purpose of this study was to understand parents’

perceptions of what influences physical activity for children with Type 1 Diabetes Mellitus

and to inform the practice of those working with children who have Type 1 Diabetes

Mellitus. This study highlights that parents serve as gate-keepers for children physical

activity.The findings provide insight in personnel involved in the supervision of children

physical activities. Healthcare providers should collaborate with families to ensure

understanding of how to manage physical activity.