News in brief: Call for school nurses to manage T1D; Evening exercise has better metabolic benefit; Education fails to improve inpatient glycaemia

Wednesday, 2 Jun 2021

Call for school nurses to manage T1D

The availability of school nurses to administer insulin would reduce the load on mothers of young children with type 1 diabetes.

A qualitative study comprising semi-structured telephone interviews with 14 mothers of children with diabetes found their experiences included the stigma of advocating for their children, being worried about their child’s safety in other people’s care, restricted employment, wanting their child to be like everyone else, and providing 24/7 care behind the scenes.

It said facilitators of intensive insulin therapy were collaborative partnerships between parents and school staff, diabetes education for school staff, reasonable adjustments for integrated care and the use of continuous glucose monitoring systems.

The study said most schools do not employ school nurses – leaving the responsibility on teaching and administration staff which transfers to the parents.

“This paper provides an awareness of the disconnect between mandatory school attendance, accessing education on the same basis as others according to the Disability Standards for Education, and the availability of school nurses to legally administer insulin.”

Australian Journal of Advanced Nursing

Evening exercise has better glycaemic benefit

Marked alterations in circulating biomarkers of metabolic health after a short-term high-fat diet (HFD) are only partially reversed by exercise training in the evening.

A study of 14 overweight/obese men found a five-day HFD led to changes in the circulating levels of several lipid and amino acid metabolites.

Men who exercised at any time of day subsequently had improvements in cardiorespiratory fitness compared to men who did not exercise but only the evening exercisers had improved nocturnal glycaemic control on the days they exercised.

The investigators said performing exercise in the afternoon or early evening may confer the greatest metabolic health benefits.

“Optimising both the timing of exercise and meals may have additive effects on the circadian clock and circulating metabolite profiles to further improve metabolic health.”


Education intervention fails to improve inpatient glycaemia

The use of decision-support algorithms with education on glycaemia and lipid management in the post-CABG surgery setting does not optimise blood glucose levels in patients with diabetes.

A study of 200 patients from the Fiona Stanley Hospital in WA found the intervention did not improve inpatient glycaemia, increase non-statin lipid lowering prescriptions, or reduce re-admissions to hospital within 30 days of surgery.

However the intervention did reduce the length of stay in the cardiac surgery unit and reliance on endocrinology specialist input.

“The preference for prescribing SGLT2 inhibitor therapy rather than insulin at discharge also required less endocrinology input. In addition, the establishment of an inter-speciality approved management algorithm likely improved clinician confidence in managing diabetes, thereby limiting endocrinology referrals to more complex cases,” it said.

The study also found initiation of SGLT2 inhibitors near the time of hospital discharge was not associated with significant harm.

Internal Medicine Journal


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