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Monitoring, discussion effective for adolescents with diabetes
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Periodic monitoring and discussion of health-related quality of life positively affected psychosocial well-being for adolescents with type 1 diabetes, except for those with poorest control, according to recent data.
Researchers from The Netherlands conducted a controlled trial at four centers. They randomly assigned adolescents to an intervention group (n=46) or a control group (n=45); three visits were scheduled for both groups within 12 months.
Improvements were seen in mean score on the Child Health Questionnaire for psychosocial health, behavior, mental health and family activities (all P,.001) in the intervention group except for adolescents with the highest HbA1c values, according to the researchers.
Adolescents in the intervention group reported higher self-esteem (P=.016) and were more satisfied with care (P=.009) than adolescents in the control group. There were no significant differences in HbA1c levels between groups, according to the researchers.
“Implementing a computer-assisted health-related quality of life intervention in routine pediatric diabetes care was feasible, well appreciated by adolescents and providers and resulted in significant improvements in psychosocial well-being,” the researchers wrote. – by Christen Haigh
Diabetes Care. 2008;31:1521-1526.
The results of this study from the Netherlands demonstrate that a quality-of-life intervention in adolescents with type 1 diabetes mellitus has positive effects on their psychosocial well-being, an exception being those already with the worst control. Such interventions may be possible in a one-payor National Health Service but are unlikely to be funded in a market-driven health care system. Nor is it clear that this intervention could be implemented in a ‘practical’ clinic setting as opposed to the research setting of this study. Moreover, improved self-esteem in the absence of improvement in HbA1c or other indices of improved metabolic control may be difficult to justify when resources are limited. Support groups such as the American Diabetes Association and Juvenile Diabetes Research Foundation possibly provide similar benefits, though this has not been rigorously tested. Finally, it is distressing that those who might benefit the most — the rebellious adolescents with the poorest metabolic control — are impervious to these personal and individualized interventions.
– Mark A. Sperling, MD
Endocrine Today Editorial Board member