Impact of family‐centered tailoring of pediatric diabetes self‐management resources

Abstract

BackgroundThe American Diabetes Association recommends a family‐centered approach that addresses each family's specific type 1 diabetes self‐management barriers.ObjectiveTo assess an intervention that tailored delivery of self‐management resources to families' specific self‐management barriers.SubjectsAt two sites, 214 children 8‐16 years old with type 1 diabetes and their parent(s) were randomized to receive tailored self‐management resources (intervention, n = 106) or usual care (n = 108).MethodsOur intervention (1) identified families' self‐management barriers with a validated survey, (2) tailored self‐management resources to identified barriers, and (3) delivered the resources as four group sessions coordinated with diabetes visits. Mixed effects models with repeated measures were fit to A1c as well as parent and child QOL during the intervention and 1 year thereafter.ResultsParticipants were 44% youth (8‐12 years) and 56% teens (13‐16 years). No intervention effect on A1c or QOL was shown, combining data from sites and age groups. Analyzing results by site and age group, post‐intervention A1c for teens at one site declined by 0.06 more per month for intervention teens compared to usual care (P < 0.05). In this group, post‐intervention A1c declined significantly when baseline A1c was >8.5 (−0.08, P < 0.05), with an even larger decline when baseline A1c was >10 (−0.19, P < 0.05). In addition, for these teens, the significant improvements in A1c resulted from addressing barriers related to motivation to self‐manage. Also at this site, mean QOL increased by 0.61 points per month more during the intervention for parents of intervention youth than for usual care youth (P < 0.05).ConclusionsTailored self‐management resources may improve outcomes among specific populations, suggesting the need to consider families' self‐management barriers and patient characteristics before implementing self‐management resources.

Pre‐empting the challenges faced in adolescence: A systematic literature review of effects of psychosocial interventions for preteens with type 1 diabetes

“…Glycemic control was evaluated by measuring blood glucose in one of the interventions, and glycosylated haemoglobin (HbA1c) was the primary outcome in over half of the interventions (6 out of 11). Of these six interventions, improved blood glucose/HbA1c levels post‐intervention were shown in 5 and enhanced levels by a one percentage point in the remaining one . Also, three of these interventions displayed an effect in older participants only (11‐ to 13‐, 13‐ to 16‐ and 12‐ to 14‐year‐olds) …”

“…Five interventions measured diabetes treatment self‐management using the Diabetes Self‐Management Profile (DSMP), which is a tailored version for nonprofessional interviewers, and behavioural and self‐monitoring checklists together . The DSMP includes 23 questions assessing 5 aspects of self‐management: exercise, management of hyperglycaemia, diet, blood glucose testing and insulin administration and dose adjustment.…”

“…The main reason for downgrading a point on this category was the recommendation regarding the right to comprehensive expert, structured education for every young person , owing to the diabetes duration criterion and other exclusion criteria such as the most recent HbA1c levels and being a girl with menarche . All of the programmes accomplished at least 50% of the universal principle's recommendations.…”

“…Of the 11 interventions, all qualified as being adequately reported except for the paper by Streisand and Mednick, which did not accomplish any of the reporting questions evaluated. Regarding the remaining 10 interventions, all of them reported adequately their methods of analysis, and the main weak point was the second question, where only four of them included an explicit description of and reason for their selection of participants.…”

Using Person-Reported Outcomes (PROs) to Motivate Young People with Diabetes

“…Motivation has been identified as the most common barrier to self-management [6,7] as well as one of the most important outcomes that matter to young people with T1D [8]. Hence, to support young people with T1D to achieve optimal clinical and mental health outcomes, it is crucial for diabetes care providers to understand the components of youth motivation for behavior change as well as maintenance of healthy selfmanagement behaviors [9][10][11].…”