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Running head: TYPE-II DIABETES AMONG CHILDREN
Clinical Symptoms Preceding Diagnosis with Type-II Diabetes among Children
Christina M. Leonard
Alverno College
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ABSTRACT
In this exploratory, quantitative study, the purpose will be to identify the clinical signs and symptoms of Type-II Diabetes in children, which preceded their diagnosis. The theoretical framework used in this study is the Theory of Unpleasant Symptoms.
Studying the clinical signs and symptoms related to the diagnosis of this disease in children will help nurses to educate and increase awareness among health care staff, school nurses and administration, and parents to be aware of the signs and symptoms of this disease. The results of the study will aid in early diagnosis and treatment, as well as reducing potential long term complications.
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TABLE OF CONTENTS
ABSTRACT……………………………………………….. Page 2
INTRODUCTON……………………………………………Page 4
Purpose of Study………………………………………. Page 5
Significance to Nursing……………………………….. Page 5
Statement of Research Question………………………. Page 6
Conceptual Framework………………………………... Page 6
Conceptual and Operational Definition of Terms …...... Page 6
Summary………………………………………………. Page 8
REVIEW OF LITERATURE……………………………… Page 7
Review of Key Concepts………………………………. Page 8
Background……………………………………………. Page 9
Measurement Tools……………………………………. Page 14
Hypotheses…………………………………………….. Page 14
Summary………………………………………………. Page 14
METHODS
Design…………………………………………………. Page 15
Sample and Setting……………………………………. Page 15
Protection of Right of Participants……………………. Page 16
Data Collection Procedures ………………………...... Page 16
Plan for Data Analysis……………………………….... Page 16
Data Collection Tools…………………………………. Page 15
Assumptions……………………………………………Page 19
Limitations……………………………………………. Page 19
Summary……………………………………………….Page 19
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Introduction
Type-II Diabetes is now a recognized epidemic among American children, and its incidence continues to increase. Type-II Diabetes used to occur mainly in adults who were overweight and ages 40 and older. However, as more children in the United States are overweight and inactive, Type-II Diabetes is occurring more often in young people. According to the National Diabetes Education Program, currently 10-15% of children and teens are overweight, which is double the number two decades ago – leading to an increasing number of young people with Type-II Diabetes (National Diabetes Education Program, 2007). According to the Centers for Disease Control and Prevention (CDC), overweight is defined as at or above the 95th percentile on the CDC’s Body Mass Index (BMI) for age growth charts (Center for Disease Control, 2007).
According to the National Diabetes Education Program, in Type-II Diabetes, either the body does not produce enough insulin or the cells ignore the insulin being produced. Insulin is necessary for the body to be able to use sugar. This is important to understand because sugar is the basic fuel for the cells in the body, and insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can cause two problems: one, it can starve cells of energy, and two, over time high blood glucose levels may damage the eyes, kidneys, nerves and heart (National Diabetes Education Program, 2007).
The risk factors of Type-II Diabetes are being overweight, having family history of the disease, belonging to a member of a high risk ethnic group and being older than 10
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years old. Type-II Diabetes is a gradual onset of clinical manifestations. Common clinical manifestations, if present, include fatigue, increased thirst, nausea, and frequent
urinating, although some children may experience no clinical manifestations at all. If this disease is undiagnosed in children it may place these children at risk for cardiovascular disease and other significant complications.
The new epidemic of American children with Type-II Diabetes is important to study so that nurses are educated on awareness of this disease, diagnosis of the disease and prevention strategies/education. With research on this topic, new knowledge can be shared with not only other health care providers but school nurses and administrators, and parents as well. In the end, with this knowledge nurses will be able to lessen the number of children diagnosed with Type-II Diabetes.
Purpose of Study
In this exploratory, quantitative study, the purpose will be to identify the clinical signs and symptoms of Type-II Diabetes in children, which preceded their diagnosis. The main purpose of studying this research is to be able to recognize the clinical manifestations children experience before their diagnosis of Type-II diabetes. With this knowledge health care professionals, specifically nurses will better be detect and prevent Type-II diabetes, recognize the early onset of this disease, and effectively and promptly diagnosis it. Recognition of prodromal symptoms experienced by children will contribute to recognition at an early stage, thus reducing long term complications from Type-II diabetes.
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Significance to Nursing
Studying the clinical signs and symptoms related to the diagnosis of this disease in children will help us to educate and increase awareness among health care staff, school nurses and administration, and parents to be aware of the signs and symptoms of this disease. The results of the study will aid in early diagnosis, early treatment interventions and reduced risk of complications related to the diagnosis. The nurses’ role in this research is to become knowledgeable about this disease in children, to educate parents and children, and to raise awareness of this new health care epidemic.
Statement of Research Question
The scientific research question examined in this study was, “What are the clinical symptoms that children ages 8 to 14 exhibit six months to a year before they are diagnosed with Type-II Diabetes?”
Conceptual Framework
The conceptual framework for this research proposal is the Theory of Unpleasant Symptoms. According to Lenz, the three main components of the theory are the symptoms the client is experiencing, the influencing factors that give rise to the nature of the symptom, and the consequences of the symptom experience (Lenz, 1997). The three different factors influencing the symptoms according to this theory are the physiological, psychological and situational factors. In this theory, there are four factors that are contained within a symptom; they include distress, duration, intensity, and quality. All of the previous aspects of the theory of unpleasant symptoms, in the end, affect performance of the individual. This theory will be used to evaluate the results of the symptoms survey
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that the participants in this research will be asked to complete. It will shed light on the actual symptoms the child is experiencing, why the symptoms are occurring and what consequences result from their symptoms.
Conceptual and Operational Definition of Terms
The concepts related to the theoretical framework in this research proposal are symptoms, physiological factors, psychological factors, situational factors, duration, distress, intensity, quality, and performance. According to Hegyvary, symptoms are
defined as perceived indicators of change in normal functioning as experienced by patients (Hegyvary, 1993). Physiological factors are defined as normal systems,
pathogenic problems and energy substrate (Lenz, 1997). Psychological factors relate to mental state and reaction to illness (Lenz, 1997). Situational factors of this theory incorporate lifestyle and personal experiences (Lenz, 1997). According to Lenz, the four factors of a symptom are defined as follows: duration is defined as timing and frequency of symptoms; distress is degree of discomfortness or bothersomeness of the symptom; intensity is referred to as the severity, strength or amount of symptom be experienced; and quality is vocabulary used to describe symptom (Lenz, 1997). According to Lenz, performance is defined as physical activity, activities of daily living, social activities and role-related tasks (Lenz, 1997). The operational definition of symptoms are the participants responses about symptoms experienced and reported on the symptom survey data collection tool.
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Summary
The first section of this research proposal gives an introduction, familiarizing readers with the topic, the purpose of the study and its significance to nursing. The statement of the research proposal and the theoretical framework related to this research study were described. The Theory of Unpleasant Symptoms is described and the conceptual and operational definitions are provided. Finally there is a summary of the research proposal. In this quantitative study, prodromal signs and symptoms experienced by children who are eventually diagnosed with Type-II Diabetes are explored. The results of this research
give nurses information to educate health care staff, school nurses and administration, and parents about this disease. The goal of nursing care is diagnosing diabetes early in
these children so that they will have a better prognosis and get the appropriate treatment they need.
REVIEW OF LITERATURE
There are several key concepts to understand when studying Type-II Diabetes in children: According to the American Heart Association, diabetes mellitus is a disease in which the body doesn't produce or properly use insulin; insulin is a hormone produced in the pancreas, an organ near the stomach. Insulin is needed to turn sugar and other food into energy (Zietler, 2007, p. 1823). The Pancreas is a gland organ in the digestive and endocrine systems of vertebrates. Risk factors for this disease are: Acanthosis nigricans, hyperpigmenation and thickening of the skin into velvety irregular folds in the neck and flexural areas reflects chronic hyperinsulinemia (excess insulin in the blood) (Zietler, 2007, p. 172); hypertension, high blood pressure; dyslipidemia, increased fat in the blood
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(of often related to prolonged elevation of lipid (fat) levels). According to the American Diabetes Association, hyperglycemia is the technical term for high blood glucose (sugar). High blood glucose happens when the body has too little, or not enough, insulin or when the body can't use insulin properly (American Diabetic Association, 2007). Ketoacidosis is a type of metabolic acidosis which is caused by high concentrations of ketone bodies, formed by the deamination of amino acids, and the breakdown of fatty acids, it is a serious condition that can lead to diabetic coma (passing out for a long time) or even death (American Diabetic Association, 2007).
Background
“There is a new epidemic upon us,” says White, professor of pediatrics and of medicine at the School of Medicine and a pediatric endocrinologist at
St. Louis Children’s Hospital, affiliated with the School of Medicine; “Over the past decade, it has become apparent that type II diabetes, previously a disorder primarily of adults, is developing at an alarming rate in teenagers and preteens” (Medical Letter on the CDC & FDA, 2007). Diabetes Mellitus is a disease in which blood sugar is elevated. Type-II Diabetes is a disorder associated with the need for more insulin to regulate metabolism, however the pancreas is not able to produce the extra insulin the body needs. There are many long term complications associated with this disorder, if not properly diagnosed or medically managed, which are of concern, such as vision loss, kidney failure, nerve damage and blood vessel damage. These complications can then lead to blindness, kidney failure, heart attack, stroke and even amputation of extremities.
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According to Silvertein et al., “Type 2 diabetes accounts for 8 to 45 percent of new childhood diabetes.” “High-risk youths older than 10 years have a body mass index greater than the 85th percentile for age and sex plus two additional risk factors (i.e., family history, high-risk ethnicity, acanthosis nigricans, polycystic ovary syndrome, hypertension, or dyslipidemia) (2007, p. 658).” According to Peterson, Silvertein, Kaufman, and Warren-Boulton, more than 13,000 youths are diagnosed with diabetes every year, making it one of the most common chronic childhood diseases in the United States (2007). This epidemic is due to the increased amount of youth being overweight and/or obese. “The national prevalence of overweight and obesity in school-
aged children (8-12 years) has nearly quadrupled in the last 25 years (Silvertein et al., 2007). According to Peterson, K, Silvertein, J, Kaufman, F., & Warren-Boulton, E (2007), approximately 30% of children (ages 6 to 11) are overweight/obese.
Obesity that begins in childhood may be more closely associated with severe obesity in adulthood than obesity that begins in adulthood (Chan, et al., 2005). Knowing this information early detection and treatment interventions directed towards young children who are overweight/obese is very important in preventing type II diabetes, as well as the complications of this disorder. Body mass index (BMI, [calculated as weight in kilograms divided by the square of height in meters]) is the most widely accepted method used to screen for obesity in children and adolescents because the measurements needed to calculate BMI are noninvasive (Singhal, et al., 2007). According to Singhal et al. (2007) body mass index is a reliable indicator if body fat content for most children and adolescents, it correlates well to direct measures of body fat (2007). Additionally, BMI
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has been found to correlate well with obesity-related complications (Singhal, et al., 2007).
Singhal et al., state that a fasting glucose greater than 100 mg/dl is considered prediabetic, and a level greater than or equal to 126 mg/dl is consistent with the diagnosis of diabetes (2007). Fasting serum triglyceride levels are often elevated in obesity and are considered an early sign of metabolic syndrome. Children with total triglyceride levels greater than 200 mg/dl should be followed up closely (Singhal, et al, 2007). This is the information that needs to be screened by health care professionals and talked to with the families of these children to initiate early interventional measures. It is also important to
talk to the families about weight loss, dietary management, physical activity and if needed, pharmacological therapy.
According to Zeitler, the mean age of adolescents with Type-II Diabetes has ranged from 13 to 14 years in various series, and though rare, children as young as 5 years of age have been reported (2007). Zietler goes on to state, in reported series, patients with Type-II Diabetes are almost always in puberty, the age of these children is sometimes surprisingly young because the age of onset of puberty among obese children may be earlier than among their peers (2007). Since puberty is characterized by relative insulin resistance, it is thought that puberty may promote the appearance of overt Type-II Diabetes in obese adolescents (Zietler, 2007). Also, according to Zeitler, girls are more susceptible to Type-II Diabetes than boys, with an overall female-to-male ratio of 1.7:1 regardless of race (Zietler, 2007). However since these ratios are based on studies from diabetes centers and not from population screening, the gender discrepancy nay result