Type 1 Diabetes Mellitus (T1DM) self management in hospital; is it possible? A literature review

Aim: To review research evidence on the adults with Type I Diabetes Mellitus's ability to continue self management in the hospital setting. Background: A person with Type 1 Diabetes Mellitus requires a daily management routine to control glycaemia levels known as self management. On admission to hospital anecdotal evidence suggests people with Type 1 Diabetes Mellitus are managed by health professionals and self management is difficult. A review of the literature is required to explore the anecdotal evidence. Design: A literature review of available primary peer reviewed research on self management of Type 1 Diabetes Mellitus in hospital. Method: A systematic search of the literature published between 1998 - 2008 was undertaken to identify research available on self management of Type 1 Diabetes Mellitus in hospital. The mixed methods review was conducted using critique tools for randomised control trials, qualitative and quantitative studies. Four main themes were identified; Glycaemic control, development of self management, the expert patient and T1DM management in hospital. Results: Sixteen related publications were identified. In the context of their daily life adults with Type 1 Diabetes Mellitus perceive their ability to self manage as important and view themselves as 'experts' in their self management. However, there is a recognised conflict about Type 1 Diabetes Mellitus management between the 'expert' and health professional. Furthermore, management of Type 1 Diabetes Mellitus by health professionals in the hospital setting has been identified as having a biomedical focus and being poorly managed. Conclusion: People with Type 1 Diabetes Mellitus have knowledge and skills to self manage. Whilst there is support for adults to actively self manage their illness to maintain glycaemic control, there is no support in the literature regarding a continuation of self management in the hospital setting.