Management of adolescents with very poorly controlled type 1 diabetes by nurses: a parallel group randomized controlled trial

Abstract

BackgroundsFluctuation in glycemia due to hormonal changes, growth periods, physical activity, and emotions make diabetes management difficult during adolescence. Our objective was to show that a close control of patients’ self-management of diabetes by nurse-counseling could probably improve metabolic control in adolescents with type 1 diabetes.MethodsWe designed a multicenter, randomized controlled, parallel group, clinical trial. Seventy seven adolescents aged 12–17 years with A1C >8 % were assigned to either an intervention group (pediatrician visit every 3 months + nurse visit and phone calls) or to the control group (pediatrician visit every 3 months). The primary outcome was the evolution of the rate of A1C during the 12 months of follow-up. Secondary outcomes include patient’s acceptance of the disease (evaluated by visual analog scale), the number of hypoglycemic or ketoacidosis episodes requiring hospitalization, and evaluation of A1C rate over time in each group.ResultsSeventy-seven patients were enrolled by 10 clinical centers. Seventy (89.6 %) completed the study, the evolution of A1C and participants satisfaction over the follow-up period was not significantly influenced by the nurse intervention.ConclusionNurse-led intervention to improve A1C did not show a significant benefit in adolescents with type 1 diabetes because of lack of power. Only psychological management and continuous glucose monitoring have shown, so far, a slight but significant benefit on A1C. We did not show improvements in A1C control in teenagers by nurse-led intervention.Trial registrationClinical Trials.gov registration number: NCT00308256, 28 March 2006.

Health system responses for type 1 diabetes: A scoping review

“…The education programs aimed to enhance knowledge and self‐efficacy so patients and parents become capable of conducting day‐to‐day diabetes care. Role expansion or task shifting subcategories were less frequent (4, 2.5%) 29 , 30 , 31 , 32 , 33 and included task shifting to specialized nurses or community health care workers.…”

The process of managing the children with type 1 diabetes in the family: A grounded theory study

“…The result did not explain improvements in A1C control in teenagers by nurse-led intervention. [ 43 ]…”

Technological Ecological Momentary Assessment Tools to Study Type 1 Diabetes in Youth: Viewpoint of Methodologies

“…Furthermore, Bergner et al [275] found that youths with T1D found a text-based system for a positive psychology intervention more acceptable than phone call-based systems. However, although some studies have found that app-and phone-based program usage can improve T1D not all found statistically significant differences [282,287], and some found increased patient burden. For example, studies have shown increased conflict in families with app usage, including an increased perception of conflict about logging blood sugars, a sense of increased nagging from parents if the youths checked their glucose irregularly, decreased caring behaviors from parents, and increased unsupportive behaviors from parents [263,281].…”