الفهرس 
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Abstract
Type 1 diabetes mellitus is a multifactorial autoimmune disease; it results in
complete destruction of pancreatic beta cells and absence of insulin production, due to
multiple genetic and environmental influences. Compliance towards the therapeutic
regimen has the main influence on the quality of metabolic control of children with T1DM.
Poor compliance has been correlated with poor clinical outcomes, increasing their risk for
morbidity and premature mortality. Enhancement of the role of a pediatric nurse in caring
for children with T1DM results in an improvement in children’s outcomes and care
process.
The aim of the current study was to assess the level of compliance with the
therapeutic regimen among children having T1DM.
Materials and method
The study was conducted at the Endocrine Clinic of Alexandria University
Children’s Hospital. A convenient sample of 100 children having T1DM fulfilled the
following criteria were included:
Aged from 6-15 years old.
Free from other diseases.
Diagnosed with T1DM for not less than six months ago.
Three tools were used to collect the necessary data. Those tools were developed by
the researcher after thorough review of literature.
Tool I: Compliance with Therapeutic Regimen among Children Having
Type 1 Diabetes Mellitus Structured Interview Schedule:-
It was divided into three parts to obtain data about sociodemographic data, medical
history and to assess compliance of children having T1DM with their therapeutic regimen
in a form of questions which are related to compliance to the therapeutic regimen. Three
points Likert scale was used to assess the response to questions as follows: always done
items were given a score (2), sometimes given a score (1) and never given a score (0).
Compliance with therapeutic regimen was graded as Good, Fair and Poor (Appendix I).
Tool II: Anthropometric Measurements Sheet.
It is used to record children’s weight, height and body mass index and compare to the
average for age and gender on percentile chart (Appendix II).
Tool III: Laboratory Investigations Record.
It used to record results of FBG and HbA1c (Appendix III).
Method
1. Each child and/or his/her parent were interviewed individually to obtain the
following data:
Socio-demographic characteristics of the child with T1DM using part (1) of tool
(I).
Medical history of the disease. The history was compared with the data in the
medical record of the child using part (2) of tool (I).
Answers to questions that reflect the items of compliance to the therapeutic
regimen. Both the parents and the child were asked about the six components of
compliance using part (3) of tool (I).
Each interview session lasted for approximately 15-20 minutes.
2. Anthropometric measurements, weight, height were measured and compared with
percentile charts for age and gender. Body mass index was calculated, recorded and
compared with percentile chart for age and gender using tool (II).
3. Laboratory investigations were obtained from medical records and recorded using
tool (III).
The main results of the present study were as follows:
Forty-two percent of the studied children were at the age of 6 to less than 9 years.
Nearly half of the children (49%) were enrolled in primary school and the rest ended
between joining nursery school, preparatory school and secondary schools or not
joining the school altogether.
Two-thirds of those children (68%) were from rural areas.
The majority of the children (81%) were diagnosed with T1DM for one year or more.
Most of those children were treated with basal-bolus insulin (88%).
Only 35% of children with T1DM were performing regular sports.
About 89% of children suffered from diabetes-related complications and more than
half of them (55.1%) had a history of DKA.
More than half of children (56%) had a family history of diabetes mellitus.
Concerning compliance with the therapeutic regimen, children were poorly
compliant with the medication regimen, dietary regimen, exercise regimen, periodic
check-up and foot care regimen with the percentage of 39%, 54%, 67%, 55% and
60%, respectively. While, 62% of those children were good compliant with periodic
laboratory investigations.
Slightly more than half of those children (54%) were poorly compliant with their
overall therapeutic regimen.
Regarding children’s BMI, 60% of children had an average BMI for age and gender,
11%, 20% and 9% were underweight, overweight and obese, respectively.
As regards laboratory investigations, nearly three-quarters of children (74%) had
poorly controlled HbA1c and 73% of children had abnormal FBG results.
More than one third of children (38.9%) who were aged from 12- 15 years were
poorly compliant with their therapeutic regimen.
The majority of the children (81.5%) who had T1DM for more than one year were
poorly compliant with their therapeutic regimen.
Almost two-thirds of children (66.7%) who came from rural areas were poorly
compliant with their therapeutic regimen.
Concerning BMI, 45.5% of underweight children were poorly compliant with their
therapeutic regimen, 60% of overweight children were poorly compliant to their
therapeutic regimen and more than half (55.6%) of obese children were poorly
compliant to their therapeutic regimen.
Three-quarters (76%) of children with poor glycemic control were poorly compliant
with their therapeutic regimen.