Pre-Surgical Diabetes Education Program Increased Preparedness for Diabetes Management after Total Pancreatectomy with Islet Autotransplantation

Background: Total pancreatectomy with islet autotransplantation (TPIAT) requires families to manage diabetes with insulin pumps and continuous glucose monitors postoperatively at our institution. Education occurs while the child is hospitalized after TPIAT, and one parent or caregiver receives all education. Diabetes self-management education and support (DSMES) must be effective, efficient, and completed with enough time for families to practice before discharge. We created a pre-TPIAT diabetes education program aimed at reducing subsequent inpatient education time and increasing the primary learner’s preparedness for inpatient education. Methods: Thirty-three pediatric TPIAT recipients at Cincinnati Children’s received presurgery education across three cycles of improvement. Data were extracted from clinical records and survey responses collected. Cohorts were well-balanced demographically (all P > 0.05, small effect sizes). Survey data, including paired knowledge assessments, were collected from Cohorts 2 and 3. Results: TPIAT recipients were predominantly White (87.9%), English speaking, non-Hispanic (97.0%), with balanced sex distribution (48.5% female). Mean age at surgery was 12.2 years. Parents were primary learners in 87.9% of cases. Presurgery education time showed highly statistically significant increases in Cohorts 2 and 3 compared with Cohort 1 ( P = 0.0291 and P = 0.0007, respectively). Inpatient diabetes education showed a marginally significant decrease of 133 min from Cohort 1 to Cohort 2 ( P = 0.0717) and directionally maintained in Cohort 3 (0.3285). Assessment results documented substantial knowledge acquisition from the intervention that was retained from pre- to postsurgery education. Learner confidence increased postintervention ( P = 0.063), and overall satisfaction scores remained high except for stress/anxiety scores. Conclusion: Changes in TPIAT diabetes education delivery effectively transferred some education to presurgery without compromising content, demonstrated by a statistically significant increase in presurgery education, knowledge scores that indicated retention of information, alongside numerically lower (nonsignificant) total inpatient education time after interventions.