Introduction: When a child is diagnosed with type 1 diabetes it involves extensive lifestyle changes for the whole family. There is limited knowledge of the impact the initial care has for children and parents over time. The aim was to compare children's diabetes-specific healthrelated quality of life in hospital-based care and hospital-based home care, 12 and 24 months after the onset of type 1 diabetes. The aim was also to compare the children's and parents' proxy-report of the children's diabetes-specific health-related quality of life after 12 and 24 months, regardless of the form of care. Method: The trial took place at a university hospital in Sweden and had a randomised controlled design evaluating the hospital-based care and hospital-based home care (HBHC), referring to specialist care in a home-based setting. Children aged 5-16 and their parents answered the PedsQL TM 3.0 Diabetes Module, 12 months and 24 months after the onset of the illness. Results: The results showed no difference regarding the children's diabetes-specific healthrelated quality of life. However, 12 months from diagnosis, the children and parents who received HBHC experienced more worry than those who had received hospital-based care at diagnosis (p = 0.012). Irrespective of the form of care, children reported more discomfort of the disease than their parents reported that the children would have (p = 0.017). Conclusion: Overall, the result indicates that both hospital-based care and HBHC provide equivalent outcomes in terms of the children's diabetes-specific health-related quality of life. However, a more home-based model of care might put more strain on some families. Those families need to be identified and the routines should be flexible in order to meet each family's need.
Background: Type 1 diabetes mellitus (T1D) is the most common chronic endocrine disease among children and adolescents. Most adolescents have suboptimal glycaemic control and encounter difficulties in achieving and maintaining their target glycaemic control. This study tested the effect of a novel eHealth care programme on metabolic control and empowerment compared with the usual care among adolescents with T1D. Method: A 1-year quasi-experimental study was carried out. A total of 51 adolescents (13-16 years of age) with T1D and unsatisfactory glycaemic control (HbA1C > 57mmol/mol) were included in the study from two paediatric diabetes clinics in South Sweden. The participants were assigned to the intervention group (n=18) to receive the eHealth care programme and a matched comparison group (n=33) was taken from the National Diabetes Quality Register. Participants' changes in glycaemic control metrics between the two groups and changes in the level of empowerment among the intervention group over time as measured with the Gothenburg Young Persons Empowerment Scale (GYPES) were computed. Results: The mean age of the study participants was 14.96 years (±1.13SD) and 58.82 % (n=30) were females. During the intervention period, the mean percent time above range (% TAR) was lowered from 70.00 % to 57.43 % among the intervention group. A significant reduction in time spent in hyperglycaemia was observed in the intervention group compared with the comparison group (p < 0.001). Although not statistically significant, the mean value of the percent time in range (%TIR) increased from 26.87 % to 29.31% among the intervention group (p = 0.660). However, no significant change was observed in the remaining glycaemic control metrics between the two study groups. A significant change in the total GYPES score over time was observed among the intervention group (p = 0.002). Conclusion: Our study shows that the eHealth care programme significantly reduced %TAR and improved empowerment scores among adolescents with T1D, indicating that the intervention could be useful and effective in supporting adolescents with unsatisfactory glycaemic control. However, a randomized study with a large sample size is needed to confirm the observed and long-term effects of our intervention.
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