Randomized trial of a diabetes self-management education and family teamwork intervention in adolescents with Type 1 diabetes

• Published in: Diabetic medicine 2012-08, Vol.29 (8), p.e249-e254
• Main Authors: Murphy, H. R., Wadham, C., Hassler-Hurst, J., Rayman, G., Skinner, T. C.
• Format: Article
• Language: English
• Subjects: Adolescent; Communication; Diabetes Mellitus, Type 1 - therapy; education; Family; Group Processes; Health Education - methods; Humans; Patient Care Team - organization & administration; Self Care - methods; Social Responsibility; Treatment Outcome; Type 1 diabetes
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/j.1464-5491.2012.03683.x

Diabet. Med. 29, e249–e254 (2012) Aims  To evaluate the effectiveness of a family‐centred group education programme, in adolescents with Type 1 diabetes. Methods  Three hundred and five adolescents with Type 1 diabetes; age 13.1 ± 1.9 years, diabetes duration 5.6 ± 3.3 years, BMI 20.9 ± 3.7 kg/m2, HbA1c 78 ± 6 mmol/mol (9.3 ± 1.9%) were randomly allocated to the Families and Adolescents Communication and Teamwork Study (FACTS) diabetes education programme; (six 90‐min monthly sessions attended by parents and adolescents incorporating skills training and family teamwork) or conventional clinical care. Primary outcome was HbA1c at 18 months (12 months post‐intervention). Secondary outcomes were HbA1c at 9 months, psychosocial outcomes, adolescent quality of life, well‐being, family responsibility and insulin dose adjustment behaviours at 12 months (6 months post‐intervention) and episodes of severe hypoglycaemia and diabetic ketoacidois during the 12 months post‐intervention. All analyses are intention to treat. Results  Session attendance was poor with 48/158 families (30.4%) not attending any sessions and only 75/158 (47.5%) families attending ≥ 4 group education sessions. All biomedical and psychosocial outcomes were comparable between groups. At 18 months there was no significant difference in HbA1c in either group and no between‐group differences over time: intervention group 75 mmol/mol (9.0%) to 78 mmol/mol (9.3%), control group 77 mmol/mol (9.2%) to 80 mmol/mol (9.5%). Adolescents perceived no changes in parental input at 12 months. Conclusion  Poor attendance of group education sessions delivered in routine clinics was a major challenge. More personalized educational approaches may be required to support and motivate families who are struggling to integrate the demands of intensive insulin regimens into their daily lives.