Abstract
BackgroundProviding care for adolescents with type 1 diabetes is complex, demanding, and often unsuccessful. Guided self-determination (GSD) is a life skills approach that has been proven effective in caring for adults with type 1 diabetes. To improve care, GSD was revised for adolescents, their parents, and interdisciplinary healthcare providers (HCP) to create GSD-Youth (GSD-Y). We evaluated the impact of GSD-Y after it was integrated into pediatric outpatient visits versus treatment-as-usual, focusing on glycemic control and the development of life skills in adolescents with type 1 diabetes.MethodsSeventy-one adolescents (mean age: 15 years, mean duration of diabetes: 5.7 years, mean HbA1c: 77 mmol/mol (9.1%), upon entering the study) from two pediatric departments were randomized into a GSD-Y group (n = 37, GSD-Y was provided during individual outpatient sessions) versus a treatment-as-usual group (n = 34). The primary outcome was the HbA1c measurement. The secondary outcomes were life skills development (assessed by self-reported psychometric scales), self-monitored blood glucose levels, and hypo- and hyperglycemic episodes. The analysis followed an intention-to-treat basis.ResultsFifty-seven adolescents (80%) completed the trial, and 53 (75%) completed a six-month post-treatment follow-up. No significant effect of GSD-Y on the HbA1c could be detected in a mixed-model analysis after adjusting for the baseline HbA1c levels and the identity of the HCP (P = 0.85). GSD-Y significantly reduced the amotivation for diabetes self-management after adjusting for the baseline value (P = 0.001). Compared with the control group, the trial completion was prolonged in the GSD-Y group (P <0.001), requiring more visits (P = 0.05) with a higher rate of non-attendance (P = 0.01). GSD-Y parents participated in fewer of the adolescents’ visits (P = 0.05) compared with control parents.ConclusionsCompared with treatment-as-usual, GSD-Y did not improve HbA1c levels, but it did decrease adolescents’ amotivation for diabetes self-management.Trial registrationISRCTN 54243636, registered on 10 January 2010. Life skills for adolescents with type 1 diabetes and their parents.
Highlights
Providing care for adolescents with type 1 diabetes is complex, demanding, and often unsuccessful
Life skills for adolescents with type 1 diabetes and their parents
Twenty-seven eligible adolescents were not invited because they were usually treated by healthcare providers (HCP) who had not been Guided self-determination (GSD)-Y trained, 26 eligible adolescents declined to participate, six participated in other projects, and six lived far away and normally only attended the outpatient clinic three to four times per year
Summary
Providing care for adolescents with type 1 diabetes is complex, demanding, and often unsuccessful. We evaluated the impact of GSD-Y after it was integrated into pediatric outpatient visits versus treatment-as-usual, focusing on glycemic control and the development of life skills in adolescents with type 1 diabetes. In adolescents with type 1 diabetes, the target for glycemic control is a HbA1c level of less than 58 mmol/mol (7.5%) and an absence of frequent hypoglycemia [5]. 31% of adolescents in Denmark achieve this target (overall mean HbA1c: 70 mmol/mol, 8.6%) [6]. This result emphasizes the need for new methods to address the complexity of treating and caring for diabetes during adolescence
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
