Providing optimal service delivery for children and adolescents with type 1 diabetes: a systematic review

Abstract

The purpose of this systematic review was (1) to perform a comprehensive examination of the literature to identify aspects of service delivery which are associated with improved glycaemic control in young people with type 1 diabetes, and (2) to identify gaps in the current literature and suggest areas for future research.The online medical databases Medline, Embase, Psycinfo and Cinahl were searched using a series of keywords. We reviewed randomised controlled trials and cross‐sectional, comparison and retrospective audit studies from 1980 to December 2007 which involved children, adolescents and young adults with type 1 diabetes. In total, 540 studies were screened for inclusion, with 68 papers retrieved for further analysis 23 of which were retained for inclusion in the review.The service delivery indicators identified in the review which have an impact on glycaemic control in young people with type 1 diabetes include access to specialist care, number of clinic visits attended, access to care from a multidisciplinary diabetes team and regular telephone contact.This review confirmed that various aspects of paediatric diabetes service delivery do impact on the glycaemic control of children and adolescents with type 1 diabetes. It has also identified the need for studies to examine further the complex interplay of multiple aspects of service delivery, including the impact of a family‐centred model of care, on glycaemic control. Copyright © 2009 John Wiley & Sons, Ltd.

Working with young adults with Type 1 diabetes: Views of a multidisciplinary care team and implications for service delivery

“…Our results extend those of a previous review [17] that identified aspects of service delivery associated with improved glycaemic control in young adults and children with Type 1 diabetes. Beyond simple access to specialist multidisciplinary care, we have described the challenges for staff working in these teams, and for the young adults who may receive inconsistent messages from different team members.…”

“…We have identified some of the unique difficulties staff experience working with young adults. Although relationships between service delivery and glycaemic control are complex [17] it is clear that changes to the current service need to be made at a number of levels. These include ways in which staff work and relate to each other as well as to young adults.…”

“…Four key service indicators have been identified as contributing to adequate glycaemic control in young adults. These include access to specialist care, number of clinic visits, access to care from a multidisciplinary team and regular telephone contact [17]. Our aims were to extend these findings to determine the views of staff about the strengths and limitations of (1) current provision and (2) working with young adults.…”

Supporting disengaged children and young people living with diabetes to self-care: a qualitative study in a socially disadvantaged and ethnically diverse urban area

“…27 However, participants also observed a lack of training opportunities in schools to help teachers to improve their knowledge of diabetes care. [28][29][30][31] The overly reported challenge has been in transitions, when ironically support tends to tail off. 32 What is missing is a coordinated approach led by the health team in preventing the marginalisation of the CYPs health plans especially during stressful life events in their educational journeys, which result in high or imbalanced sugar levels leading to hospitalisation.…”

A multidisciplinary paediatric diabetes health care team: perspectives on adolescent care

“…The management of paediatric diabetes has changed since publication of the Diabetes Control and Complications Trial8 which found that habits acquired in the first year after diagnosis are hard to change, and patients who achieve good glycaemic control in the first five years do better in the longer term. Alongside this, an international systematic review found that clinic attendance, specialist care, and a multidisciplinary team approach were indicators of glycaemic control in children and young people with type 1 diabetes (T1D) 9…”