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

Aims: To evaluate theeffectiveness of a family-centred group education programme, in adolescentswith Type 1 diabetes.

 

Methods: Three hundred and fiveadolescents with Type 1 diabetes; age 13.1 ± 1.9 years,diabetes duration 5.6 ± 3.3 years, BMI20.9 ± 3.7 kg/m2, HbA1c 78 ± 6 mmol/mol(9.3 ± 1.9%) were randomly allocated to the Families and AdolescentsCommunication and Teamwork Study (FACTS) diabetes education programme; (six90-min monthly sessions attended by parents and adolescents incorporatingskills training and family teamwork) or conventional clinical care. Primaryoutcome 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 doseadjustment behaviours at 12 months (6 months post-intervention) andepisodes of severe hypoglycaemia and diabetic ketoacidois during the12 months post-intervention. All analyses are intention to treat.

 

Results: Session attendance was poorwith 48/158 families (30.4%) not attending any sessions and only 75/158 (47.5%)families attending ≥ 4 group education sessions. All biomedical andpsychosocial outcomes were comparable between groups. At 18 months therewas no significant difference in HbA1c in either group and nobetween-group differences over time: intervention group 75 mmol/mol (9.0%)to 78 mmol/mol (9.3%), control group 77 mmol/mol (9.2%) to80 mmol/mol (9.5%). Adolescents perceived no changes in parental input at12 months.

 

Conclusion: Poor attendance of groupeducation sessions delivered in routine clinics was a major challenge. Morepersonalized educational approaches may be required to support and motivatefamilies who are struggling to integrate the demands of intensive insulinregimens into their daily lives.