Abstract
Aim: To evaluate the impact of the CHOICE structured diabetes education programme for adolescents with Type 1 diabetes on glycossylated haemoglobin, body mass index, episodes of hyper and hypoglycaemia and dietary adherence. Methods: Multi-centred pragmatic randomised controlled trial (ISRCTN 13331558) across seven hospital sites in Northern Ireland, with 24 month follow-up. 135 adolescents between 13 – 19 years with Type 1 diabetes were randomly assigned to structured diabetes education (n = 70) or control (n = 65). The intervention was designed to enable adolescents to adjust diet and insulin regimens, liberating their lifestyle to more closely match that of their peers without diabetes. It consisted of 12 hours education over 4 weeks, in 3 hourly interactive, group based sessions. Clinical outcome measures included glycossylated haemoglobin (HbA1c), body mass index, number of episodes of reported hyperglycaemia and hypoglycaemia and dietary adherence. Data were analysed on an intention to treat basis and was undertaken by a series of tests assessing both within and between group differences in means, variances and covariances. Results: No significant difference between groups in HbA1c was noted despite the dietary liberation of the intervention group at 12 months however, there was a significant difference at 24 months (HbA1c IG intervention % (mmol/mol) 9.53(81) v 8.99(75) control. There was no difference in BMI or in reported hyper or hypoglycaemic episodes. Conclusion: Structured diabetes education (SDE) facilitated a more flexible diet, to which adolescents could adhere, with no detriment to glycaemic control at 12 m, but not at 24 m post intervention.
Highlights
Managing Type 1 Diabetes Mellitus (Type 1 DM) in young people requires a number of self-care practices to achieve both optimal blood glucose control and maintain good quality of life
Optimal glycaemic control remains difficult within the adolescent population
Adolescents were willing to engage with a structured education programme designed to improve diabetes control whilst enabling them to be more like their peers
Summary
Managing Type 1 Diabetes Mellitus (Type 1 DM) in young people requires a number of self-care practices to achieve both optimal blood glucose control and maintain good quality of life. To address the needs of adolescents, who may have poorer control in the teenage years [3,4] a number of educational and psychosocial interventions have been developed. In reviewing these interventions, critiques have included poor methodological practice, insufficient follow up, or insufficient power to determine their efficacy [5,6]. International policy guidelines support the need for structured diabetes education (SDE) to be available to all young people with Type 1 DM [79], yet to date there exists no widely available SDE programme tailored to the needs of adolescents within the United Kingdom (UK)
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