Improving Pediatric Type-1 Diabetes Mellitus Management in Rural Utah: A Case Study

Abstract

Introduction: Poor glycemic control has been shown to exert deleterious influences on multiple body systems. Additionally, residing in a rural area is associated with poorer diabetes care The rural adolescent patient described in this case study has a well-documented history of poor T1DM control. Her pediatric endocrinologist is located over 2 hours away from her home. Reported blood glucose levels average above 200 mg/dL, with a recent glycosylated hemoglobin (HbA1c) level of 10.3%. Previous blood glucose levels have reached an excess of 900 mg/dL. This study attempts to identify the beliefs of a rural T1DM adolescent patient, her mother, and her pediatric endocrinologist as they pertain to the patient's T1DM management. Methods: An embedded single case design with multiple embedded units of analysis was applied. Data was collected from the patient, mother, and pediatric endocrinologist between May and June of 2016. The design consisted of a mixed method approach that collected data using the Patient, Parent, and Provider Perception Questionnaire (P4Q). A triangulation of the responses from these subjects was used to elicit differences and similarities of disease management perceptions.Results: There is disconnect in diabetes care management noted in most aspects of the patient's treatment program. Interpretation: Disconnect can occur in the management of rural adolescent diabetes. Understanding theoretical propositions of the HPM may provide a pathway to limiting the shortfalls in patient care, which may lead to improvement in rural adolescent diabetes outcomes.