Abstract
AimsTo synthesise evidence from UK-based randomised trials of psycho-educational interventions in children and young people (CYP) with Type 1 Diabetes (T1D) to inform the evidence-base for adoption of such interventions into the NHS.MethodsWe searched Medline, Embase, Cochrane, PsycINFO, CINAHL, and Web of Science up to March 2016. Two reviewers independently selected UK-based randomised trials comparing psycho-educational interventions for improving management of T1D for CYP with a control group of usual care or attention control. The main outcome was glycaemic control measured by percentage of glycated haemoglobin (HbA1c); secondary outcomes included psychosocial functioning, diabetes knowledge, adverse and other clinical outcomes. A narrative synthesis and meta-analysis were conducted. Pooled effect sizes of standardised mean difference (SMD) were calculated.ResultsTen eligible trials of three educational and seven psycho-educational interventions were identified. Most interventions were delivered by non-psychologists and targeted adolescents with more than one year duration of diabetes. Meta-analysis of nine of these trials (N = 1,838 participants) showed a non-significant reduction in HbA1c attributable to the intervention (pooled SMD = -0.06, 95% CI: -0.21 to 0.09). Psycho-educational interventions aiming to increase children’s self-efficacy had a moderate, beneficial effect (SMD = 0.50, 95% CI: 0.13 to 0.87). No benefits on diabetes knowledge and other indicators of psychosocial functioning were identified.ConclusionsThere is insufficient evidence to recommend the use of particular psycho-educational programme for CYP with T1D in the UK. Further trials with sufficient power and reporting standards are needed. Future trials could consider active involvement of psychological specialists in the delivery of psychologically informed interventions and implementation of psycho-educational interventions earlier in the course of the disease.Systematic review registrationPROSPERO CRD42015010701
Highlights
Type 1 Diabetes (T1D) is one of the most common chronic diseases in childhood and adolescence, with an incidence of 28.2 new cases per 100,000 children under the age of 14 in the United Kingdom (UK) every year [1]
Meta-analysis of nine of these trials (N = 1,838 participants) showed a non-significant reduction in Haemoglobin A1c (HbA1c) attributable to the intervention
Psycho-educational interventions aiming to increase children’s self-efficacy had a moderate, beneficial effect (SMD = 0.50, 95% CI: 0.13 to 0.87)
Summary
Type 1 Diabetes (T1D) is one of the most common chronic diseases in childhood and adolescence, with an incidence of 28.2 new cases per 100,000 children under the age of 14 in the United Kingdom (UK) every year [1]. In the UK, children and young people (CYP) with T1D are usually managed by multi-disciplinary teams in hospital-based diabetes clinics. T1D management primarily aims to optimise glucose control, whilst maintaining quality of life. The gold standard for assessing average glucose control over the preceding 2–3 months is glycated Haemoglobin A1c (HbA1c) and regular testing is recommended to guide management advice. The National Institute for Health and Care Excellence (NICE) has recently recommended a target for HbA1c of 6.5% (48 mmol/ mol) or lower [6]. It is widely accepted that intensive management aiming for lower glycaemic targets confers a significant reduction in risk of diabetes-related complications [7], only 6.4% of children cared for in clinical services in England and Wales meet this target [5]
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