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Routine intervention improved glycemic control in adolescents with type 1 diabetes
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Practical, low-intensity behavioral interventions administered during routine care to families of youth with type 1 diabetes improved glycemic outcomes, demonstrating the need for disease self-management strategies.
“Adolescence can be difficult for families — even without the complex challenge of taking care of diabetes,” researcher Tonja R. Nansel, PhD, of the Prevention Research Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in a press release. “Our study found that meeting with a health advisor during regular diabetes clinic visits could help families put together strategies for dealing with diabetes to better manage the changes that occur as children take on more responsibility for their day-to-day diabetes care.”
Nansel and colleagues evaluated a 2-year behavioral intervention program that included 390 participants aged 9 to 15 years with type 1 diabetes, and their families. The multicenter, parallel-group study with equal randomization took place in four large pediatric endocrinology clinics in the United States from January 2006 to March 2009.
Families were randomly assigned to intervention or usual care based on age (9 to <12 years and ≥12 to <15 years) and HbA1c levels (≤8.3 and >8.3), researchers wrote. Questionnaires and biomedical assessments were conducted about every 3 to 4 months per clinic visit. Intervention contacts took place for 21 months per clinic visit, and telephone assessments were completed by a coordinating center at 9 to 12 months and again between the 21- and 24-month visit. Compensation was provided to both adults and children.
By 24 months, a significant overall intervention effect on change in glycemic control from baseline was observed (P=.03). Moreover, the mixed-effect model showed a significant intervention based on age (P<.001).
Among patients aged 12 to 14 years, researchers reported a significant effect on glycemic control (P=.009) for change from baseline to the 24-month interval, and also from the mixed-effect model throughout the study duration (P=.35), according to data.
However, the researchers discovered no change in glycemic control in patients aged 9 to 11 years. Additionally, there was no intervention effect on child or parent reported adherence.
“This approach appears to be better suited for the behavioral issues that the older kids were facing,” Nansel said. “The findings show us that the children who needed it most are the ones for whom this approach worked.”
Nansel and colleagues suggest further research to explore the potential mechanisms for the effect on HbA1c levels, parental involvement in the diabetes management process, conflict between parent and child, and any other behaviors not otherwise determined by the adherence measure.
Disclosure: The researchers have no relevant financial disclosures.
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