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Noyes J, Allen D, Carter C, Edwards D, Edwards RT, Russell D, Russell IT, Spencer LH, Sylvestre Y, Whitaker R, Yeo ST, Gregory JW. Standardised self-management kits for children with type 1 diabetes: pragmatic randomised trial of effectiveness and cost-effectiveness. BMJ Open 2020; 10:e032163. [PMID: 32169923 PMCID: PMC7069268 DOI: 10.1136/bmjopen-2019-032163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 12/20/2019] [Accepted: 01/09/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To estimate the effectiveness of standardised self-management kits for children with type 1 diabetes. DESIGN Pragmatic trial with randomisation ratio of two intervention: one control. Qualitative process evaluation. SETTING 11 diabetes clinics in England and Wales. PARTICIPANTS Between February 2010 and August 2011, we validly randomised 308 children aged 6-18 years; 201 received the intervention. INTERVENTION We designed kits to empower children to achieve glycaemic control, notably by recording blood glucose and titrating insulin. The comparator was usual treatment. OUTCOME MEASURES AT 3 AND 6 MONTHS: Primary: Diabetes Pediatric Quality of Life Inventory (PedsQL). Secondary: HbA1c; General PedsQL; EQ-5D; healthcare resource use. RESULTS Of the five Diabetes PedsQL dimensions, Worry showed adjusted scores significantly favouring self-management kits at 3 months (mean child-reported difference =+5.87; Standard error[SE]=2.19; 95% confidence interval [CI]) from +1.57 to +10.18; p=0.008); but Treatment Adherence significantly favoured controls at 6 months (mean child-reported difference=-4.68; SE=1.74; 95%CI from -8.10 to -1.25; p=0.008). Intervention children reported significantly worse changes between 3 and 6 months on four of the five Diabetes PedsQL dimensions and on the total score (mean difference=-3.20; SE=1.33; 95% CI from -5.73 to -0.67; p=0.020). There was no evidence of change in HbA1c; only 18% of participants in each group achieved recommended levels at 6 months. No serious adverse reactions attributable to the intervention or its absence were reported.Use of kits was poor. Few children or parents associated blood glucose readings with better glycaemic control. The kits, costing £185, alienated many children and parents. CONCLUSIONS Standardised kits showed no evidence of benefit, inhibited diabetes self-management and increased worry. Future research should study relationships between children and professionals, and seek new methods of helping children and parents to manage diabetes. TRIAL REGISTRATION NUMBER ISRCTN17551624.
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Affiliation(s)
- Jane Noyes
- School of Health Sciences, Bangor University, Bangor, UK
| | - Davina Allen
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Cynthia Carter
- School of Journalism, Media and Culture, Cardiff University, Cardiff, UK
| | - Deborah Edwards
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Management Evaluation, School of Health Sciences, Bangor University, Bangor, UK
| | - Daphne Russell
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Ian T Russell
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Llinos Haf Spencer
- Centre for Health Economics and Medicines Management Evaluation, School of Health Sciences, Bangor University, Bangor, UK
| | - Yvonne Sylvestre
- Manchester Academic Health Science (MAHSC) Clinical Trials Unit, Christie Hospital NHS Foundation Trust, Manchester, UK
| | | | - Seow Tien Yeo
- Centre for Health Economics and Medicines Management Evaluation, School of Health Sciences, Bangor University, Bangor, UK
| | - John W Gregory
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Johnson B, Norman P, Sanders T, Elliott J, Whitehead V, Campbell F, Hammond P, Ajjan R, Heller S. Working with Insulin, Carbohydrates, Ketones and Exercise to Manage Diabetes (WICKED): evaluation of a self-management course for young people with Type 1 diabetes. Diabet Med 2019; 36:1460-1467. [PMID: 31295354 DOI: 10.1111/dme.14077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2019] [Indexed: 12/22/2022]
Abstract
AIMS To evaluate a 5-day self-management education course for young people with Type 1 diabetes and assess its effects on knowledge, self-efficacy, beliefs, distress, self-management behaviours and HbA1c . METHODS This is an evaluation of a structured education course. Young people (aged 16-24 years) with Type 1 diabetes were recruited from three diabetes centres. In the first centre, participants completed self-report measures of knowledge, self-efficacy, positive and negative outcome expectancies, and hypoglycaemic worries at baseline (n=47) and the end of the course (n=42). In two additional centres, participants completed these and other measures assessing self-management behaviours, cognitive adaptation to diabetes and diabetes distress at baseline (n=32), the end of the course (n=27) and 3-month follow-up (n = 27). HbA1c levels were recorded at baseline (n=79), 6 months (n=77) and 12 months (n=65). RESULTS There were statistically significant increases in self-report knowledge, self-efficacy, positive outcome expectancies and self-management behaviours, and a statistically significant decrease in negative outcome expectances, between baseline and the end of the course. There were also statistically significant increases in self-report knowledge, self-efficacy, self-management behaviours and cognitive adaptation to diabetes between baseline and 3-month follow-up. Compared with baseline, HbA1c levels decreased by a mean (sd) of 5.44 (19.93) mmol/mol (0.48%) at 6 months (P=0.019), and by 5.98 (23.32) mmol/mol (0.54%) at 12 months (P =0.043). DISCUSSION The results indicate the potential benefits of a self-management course designed to address the developmental needs and challenges faced by young people with Type 1 diabetes. Further studies with larger numbers and appropriate controls are required to confirm these initial findings.
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Affiliation(s)
- B Johnson
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - P Norman
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - T Sanders
- Social Work, Education and Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, UK
| | - J Elliott
- Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, UK
| | - V Whitehead
- Diabetes Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - F Campbell
- Children's Diabetes Centre, Leeds Children's Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - P Hammond
- Diabetes Resource Centre, Harrogate District Hospital, Harrogate, UK
| | - R Ajjan
- Division of Cardiovascular and Diabetes Research, Leeds Institute for Genetics, Health and Therapeutics, Leeds, UK
| | - S Heller
- Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, UK
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Taha N, Mesbah N, Rahme Z, Omar D, Sukkar F. Piloting a Culturally Adapted Arabic Structured Small-Group Education Program for Adolescents with Type 1 Diabetes. Med Princ Pract 2019; 29:142-149. [PMID: 31480055 PMCID: PMC7098269 DOI: 10.1159/000503084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 09/03/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Kuwait has a high prevalence and incidence of type 1 diabetes (T1D). At present there is a need for structured educational programs (SEP) specifically tailored for Arabian youth with T1D. This SEP was locally and culturally adapted from the Kids In Control of Food (KICk-OFF) course delivered at the Dasman Diabetes Institute, Kuwait. AIMS To explore the psychological and social impact of a pilot SEP for Arabian youth with T1D and their mothers through exploring their respective perspectives. METHODS All 20 participants were interviewed using semistructured interviews individually, with a duration of approximately 30-45 min. The interviews were recorded and then transcribed verbatim. Data were analyzed using an inductive thematic approach. RESULTS The adolescents gained more self-confidence in managing their diabetes and their mothers were more confident in allowing their children take the lead in their diabetes self-management. Participants were empowered with adequate knowledge about the underlying pathophysiology of glucose metabolism and the nutritional and pharmacological management which made them feel in control and helped them to better cope with diabetes. It reduced diabetes-related family stress and gave them more social freedom, supporting behavioral change for a better lifestyle. CONCLUSIONS Attending the adapted SEP had a positive impact on adolescents with T1D and their mothers through enhancement of their knowledge and confidence, thus giving them a sense of disease control. This pilot study has proven effective in terms of enhancement of confidence in diabetes management and psychosocial factors. Therefore, there is a need for a wider implementation.
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Affiliation(s)
- Nehad Taha
- Department of Education and Training, Dasman Diabetes Institute, Kuwait, Kuwait
| | - Naglaa Mesbah
- Department of Education and Training, Dasman Diabetes Institute, Kuwait, Kuwait,
| | - Zahra Rahme
- Department of Education and Training, Dasman Diabetes Institute, Kuwait, Kuwait
| | - Dina Omar
- Department of Education and Training, Dasman Diabetes Institute, Kuwait, Kuwait
| | - Faten Sukkar
- Department of Education and Training, Dasman Diabetes Institute, Kuwait, Kuwait
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Johnston K, Wheeler G, Rosolowsky E. A Comparison of Structured Education Programs for Pediatric Patients With Type 1 Diabetes: Multiple Daily Injection Therapy Delivered by Group Workshop vs. Self-Study Course. Can J Diabetes 2019; 43:290-293. [DOI: 10.1016/j.jcjd.2018.08.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/12/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
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Klaprat N, MacIntosh A, McGavock JM. Gaps in Knowledge and the Need for Patient-Partners in Research Related to Physical Activity and Type 1 Diabetes: A Narrative Review. Front Endocrinol (Lausanne) 2019; 10:42. [PMID: 30787908 PMCID: PMC6372552 DOI: 10.3389/fendo.2019.00042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/17/2019] [Indexed: 12/12/2022] Open
Abstract
Regular physical activity (PA) is a cornerstone in the management of complications associated with type 1 diabetes (T1D). Most national guidelines advocate for regular PA for persons living with T1D, however the evidence to support these recommendations has not be reviewed recently. Additionally, in an era of patient-centered care and patient oriented research, the role of patient partners in the area of PA and T1D interventions has never been explored. The purpose of this narrative review is to overcome these two gaps in the literature. Here we review selected epidemiological evidence and identify gaps in research that would add important information to guide practitioners and future guidelines. We also provide an overview of patient-oriented research projects co-developed with persons living with T1D. Significant gaps in the field include: (1) a lack of adequately powered prospective cohort studies using serial measures of PA and hard chronic disease end-points; (2) no multi-centered, highly powered, randomized controlled trials of PA, and long-term health outcomes; (3) little data on the role of new technologies to support PA-related behavior change, and (4) no trials that involved patients in the design and execution of PA-based clinical trials. This review provides a template for scientists and patient partners to develop future research priorities and agendas in the field.
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Affiliation(s)
- Nika Klaprat
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Andrea MacIntosh
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jonathan M. McGavock
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Diabetes Action Canada SPOR Network, Toronto, ON, Canada
- *Correspondence: Jonathan M. McGavock
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Cooper H, Lancaster GA, Gichuru P, Peak M. A mixed methods study to evaluate the feasibility of using the Adolescent Diabetes Needs Assessment Tool App in paediatric diabetes care in preparation for a longitudinal cohort study. Pilot Feasibility Stud 2017; 4:13. [PMID: 28694992 PMCID: PMC5501574 DOI: 10.1186/s40814-017-0164-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 06/18/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND An evaluation study was carried out to determine the feasibility of integrating the Adolescent Diabetes Needs Assessment Tool (ADNAT) App into UK paediatric diabetes care, to ascertain best practice standards and to determine methodological recommendations for a future cohort study. METHODS A non-randomised, cohort, mixed methods study design was used to ensure equality of access to ADNAT for all participants at three sites in the North West of England. Following UK Medical Research Council guidance, the RE-AIM (reach, effectiveness (potential and perceived), adoption, implementation, maintenance) framework was used to guide study objectives and feasibility outcomes. Patients who completed ADNAT (completers) were compared with those who failed to complete (non-completers). Patients' glycaemic control (HbA1c) was accessed from their clinical data at baseline and at 6 months, alongside their ADNAT scores which were correlated with changes in HbA1c levels. The diabetes teams (respondents) completed a web-based survey and attended focus group interviews. RESULTS Eighty-nine patients were recruited. Withdrawal rates were low at 4.5% (n = 4). Forty-four patients (49.4%) completed ADNAT, leaving 45 (50.6%) non-completers. There were large baseline differences in HbA1c and variable rates of change at 6 months. After adjusting for baseline HbA1C and site in an analysis of covariance, completers had a lower post-ADNAT mean HbA1C level than non-completers at 6 months (-5.42 mmol/mol, 95% CI -11.48, 0.64). Patients' glycaemic control (HbA1c) at 6 months correlated reasonably well with their ADNAT scores (Spearman's rho = 0.46). Survey and focus group data showed that ADNAT was judged to be an effective clinical tool by the diabetes teams. Value to patients was perceived by the teams to be linked to parental support, age and previous diabetes education. The combined data triangulated. It served to capture different dimensions which were used to define changes to achieve practice standards and methodological recommendations. CONCLUSIONS The combined data showed that ADNAT has the potential to be a clinically viable tool. It has demonstrated the need for a randomised design that is tailored for a 'hard to reach' adolescent population. A cluster randomised controlled trial that involves sequential but random rollout of ADNAT over multiple time periods may be the most appropriate and is currently being considered for the larger study. TRIAL REGISTRATION NIHR Children's Clinical Research Network, UKCRN ID 6633.
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Affiliation(s)
- Helen Cooper
- Department of Public Health and Wellbeing, Clatterbridge Hospital, University of Chester, Clatterbridge Rd, Bebington, Birkenhead, Wirral CH63 4JYL UK
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children’s NHS Foundation Trust, Eaton Road, West Derby, Liverpool, L12 2AP UK
- Department of Public Health and Wellbeing, University of Chester, Riverside Campus, Castle Drive, Chester, CH1 1SL UK
| | - Gillian A. Lancaster
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, ST5 5BG UK
| | - Phillip Gichuru
- Department of Mathematics and Statistics, University of Lancaster, Lancaster, LA1 4YF UK
| | - Matthew Peak
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children’s NHS Foundation Trust, Eaton Road, West Derby, Liverpool, L12 2AP UK
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COST-EFFECTIVENESS OF STRUCTURED EDUCATION IN CHILDREN WITH TYPE-1 DIABETES MELLITUS. Int J Technol Assess Health Care 2016; 32:203-211. [DOI: 10.1017/s0266462316000507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives: Kids in Control OF Food (KICk-OFF) is a 5-day structured education program for 11- to 16-year-olds with type 1 diabetes mellitus (T1DM) who are using multiple daily insulin injections. This study evaluates the cost-effectiveness of the KICk-OFF education program compared with the usual care using data from the KICk-OFF trial.Methods: The short-term within-trial analysis covers the 2-year postintervention period. Data on glycated hemoglobin (HbA1c), severe hypoglycemia, and diabetic ketoacidosis (DKA) were collected over a 2-year follow-up period. Sub-group analyses have been defined on the basis of baseline HbA1c being below 7.5 percent (58.5 mmol/mol) (low group), between 7.5 percent and 9.5 percent (80.3 mmol/mol) (medium group), and over 9.5 percent (high group). The long-term cost-effectiveness evaluation has been conducted by using The Sheffield Type 1 Diabetes Policy Model, which is a patient-level simulation model on T1DM. It includes long-term microvascular (retinopathy, neuropathy, and nephropathy) and macrovascular (myocardial infarction, stroke, revascularization, and angina) diabetes-related complications and acute adverse events (severe hypoglycemia and DKA).Results: The most favorable within-trial scenario for the KICk-OFF arm led to an incremental cost-effectiveness ratio (ICER) of £23,688 (base year 2009) with a cost-effectiveness probability of 41.3 percent. Simulating the long-term complications using the full cohort data, the mean ICER for the base case was £28,813 (base year 2011) and the probability of the KICk-OFF intervention being cost-effective at £20,000/QALY threshold was 42.6 percent, with considerable variation due to treatment effect duration. For the high HbA1c sub-group, the KICk-OFF arm was “dominant” (meaning it provided better health gains at lower costs than usual care) over the usual care arm in each scenario considered.Conclusions: For the whole study population, the cost-effectiveness of KICk-OFF depends on the assumption for treatment effect duration. For the high baseline HbA1c sub-group, KICk-OFF arm was estimated to be dominant over the usual care arm regardless of the assumption on the treatment effect duration.
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Price KJ, Knowles JA, Fox M, Wales JKH, Heller S, Eiser C, Freeman JV. Effectiveness of the Kids in Control of Food (KICk-OFF) structured education course for 11-16 year olds with Type 1 diabetes. Diabet Med 2016; 33:192-203. [PMID: 26248789 DOI: 10.1111/dme.12881] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2015] [Indexed: 12/21/2022]
Abstract
AIM To assess the effect of a 5-day structured education course (Kids in Control of Food; KICk-OFF) on biomedical and psychological outcomes in young people with Type 1 diabetes. METHODS This was a cluster-randomized trial involving 31 UK paediatric centres. Participants were recruited prior to stratified centre randomization. Intervention centres delivered KICk-OFF courses, whereas control centres delivered usual care. Participants were 11-16 years of age and had Type 1 diabetes for at least one year. The KICk-OFF course was delivered by trained educators to eight participants per course. Glycaemic control and quality of life were measured at baseline, 6, 12 and 24 months. Secondary outcomes were hypoglycaemia, ketoacidosis, fear of hypoglycaemia and diabetes self-efficacy. RESULTS Three hundred and ninety-six participants provided baseline data (199 intervention and 197 control). At 6 and 12 months the intervention group showed significantly improved total generic quality of life scores compared with controls (baseline: 80 vs. 82; 6 months: 82 vs. 82; P = 0.04). Across the whole intervention group mean HbA1c levels were not significantly different from controls; baseline HbA1c mean (95% confidence interval), 78 mmol/mol (75-81) vs. 76 mmol/mol (74-79) [9.3% (9-9.6%) vs. 9.1% (8.9-9.4%); 24 months: 77 mmol/mol (74-79) vs. 78 mmol/mol (75-81) (9.2% (8.9-9.4%) vs. 9.3% (9-9.6%)], adjusted mean difference, -2.0 mmol/mol (6.5-2.5) [2.3% (-2.7% to 2.4%)], P = 0.38. CONCLUSIONS Attending a KICk-OFF course was associated with significantly improved total quality of life scores within 6 months. Glycaemic control, as measured by HbA1c , was no different at 24 months. (Clinical Trial Registry No: ISRCTN3704268).
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Affiliation(s)
- K J Price
- Sheffield Children's Hospital, Sheffield, UK
| | - J A Knowles
- Sheffield Children's Hospital, Sheffield, UK
| | - M Fox
- Sheffield Children's Hospital, Sheffield, UK
| | - J K H Wales
- Department of Child Health, University of Sheffield, Sheffield Children's Hospital, Sheffield, UK
| | - S Heller
- Department of Human Metabolism, University of Sheffield, Sheffield, UK
| | - C Eiser
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - J V Freeman
- Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
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Sawtell M, Jamieson L, Wiggins M, Smith F, Ingold A, Hargreaves K, Khatwa M, Brooks L, Thompson R, Christie D. Implementing a structured education program for children with diabetes: lessons learnt from an integrated process evaluation. BMJ Open Diabetes Res Care 2015; 3:e000065. [PMID: 25969740 PMCID: PMC4419460 DOI: 10.1136/bmjdrc-2014-000065] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/27/2015] [Accepted: 02/03/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is recognition of an urgent need for clinic-based interventions for young people with type 1 diabetes mellitus that improve glycemic control and quality of life. The Child and Adolescent Structured Competencies Approach to Diabetes Education (CASCADE) is a structured educational group program, using psychological techniques, delivered primarily by diabetes nurses. Composed of four modules, it is designed for children with poor diabetic control and their parents. A mixed methods process evaluation, embedded within a cluster randomized control trial, aimed to assess the feasibility, acceptability, fidelity, and perceived impact of CASCADE. METHODS 28 pediatric diabetes clinics across England participated and 362 children aged 8-16 years, with type 1 diabetes and a mean glycosylated hemoglobin (HbA1c) of 8.5 or above, took part. The process evaluation used a wide range of research methods. RESULTS Of the 180 families in the intervention group, only 55 (30%) received the full program with 53% attending at least one module. Only 68% of possible groups were run. Staff found organizing the groups burdensome in terms of arranging suitable dates/times and satisfactory group composition. Some staff also reported difficulties in mastering the psychological techniques. Uptake, by families, was influenced by the number of groups run and by school, work and other commitments. Attendees described improved: family relationships; knowledge and understanding; confidence; motivation to manage the disease. The results of the trial showed that the intervention did not significantly improve HbA1c at 12 or 24 months. CONCLUSIONS Clinic-based structured group education delivered by staff using psychological techniques had perceived benefits for parents and young people. Staff and families considered it a valuable intervention, yet uptake was poor and the burden on staff was high. Recommendations are made to inform issues related to organization, design, and delivery in order to potentially enhance the impact of CASCADE and future programs. CURRENT CONTROLLED TRIALS ISRCTN52537669.
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Affiliation(s)
- Mary Sawtell
- Social Science Research Unit, UCL Institute of Education, London, UK
| | - Liz Jamieson
- Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Meg Wiggins
- Social Science Research Unit, Institute of Education, London, UK
| | - Felicity Smith
- Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Anne Ingold
- Social Science Research Unit, Institute of Education, London, UK
| | | | - Meena Khatwa
- Social Science Research Unit, Institute of Education, London, UK
| | - Lucy Brooks
- Medical Statistics Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Thompson
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Deborah Christie
- University College London Hospitals NHS Foundation Trust, London, UK
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Soni A, Ng SM. Intensive diabetes management and goal setting are key aspects of improving metabolic control in children and young people with type 1 diabetes mellitus. World J Diabetes 2014; 5:877-881. [PMID: 25512790 PMCID: PMC4265874 DOI: 10.4239/wjd.v5.i6.877] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/05/2014] [Accepted: 10/27/2014] [Indexed: 02/05/2023] Open
Abstract
Diabetes control in children remains poor in spite of advances in treatment for last 10 years. The aim of this review was to look at various aspects of intensive therapy in the management of type 1 diabetes such as insulin regimes, role of target setting, psycho-educational approaches and self-management. To achieve good metabolic control, clear goal setting with adequate support for self-management are essential. Psycho-educational and behavioural interventions aimed at specific areas of management have shown significant improvement in quality of life and diabetes control.
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Smart CE, Annan F, Bruno LPC, Higgins LA, Acerini CL. ISPAD Clinical Practice Consensus Guidelines 2014. Nutritional management in children and adolescents with diabetes. Pediatr Diabetes 2014; 15 Suppl 20:135-53. [PMID: 25182313 DOI: 10.1111/pedi.12175] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 06/11/2014] [Indexed: 12/13/2022] Open
Affiliation(s)
- Carmel E Smart
- Department of Endocrinology, John Hunter Children's Hospital, Newcastle, Australia
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