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Educational intervention ineffective in children with type 1 diabetes
An intervention program in the United Kingdom aimed at using psychological delivery methods to educate children and adolescents on diabetes control failed to improve participants’ HbA1c, according to study data published in BMJ Open Diabetes Research and Care.
Researchers cited organizational difficulties as some of the reasons for the intervention’s failure.
“Type 1 diabetes is a common chronic condition in which control of glycemia in childhood and adolescence is strongly predictive of later diabetic complications,” Deborah Christie, PhD, of University College London Hospitals NHS Foundation Trust, and colleagues wrote. “Yet the majority of children and adolescents with [type 1 diabetes] have poor glycemic control, even in high-income countries.”
The researchers carried out a cluster-randomized pragmatic trial to study the effects of the Child and Adolescent Structured Competencies Approach to Diabetes Education (CASCADE), a four-module education program in which families attended one module a month during a 4-month period. A total of 362 children aged 8 to 16 years, along with their families, were recruited from several diabetes clinics. Module 1 focused on nutrition, module 2 centered on blood testing, module 3 provided information on insulin management and module 4 aimed to educate patients on living with diabetes.
Patients who provided after 12 months (n = 298) and 24 months (n = 284) showed no improvement in their glycemic control (intervention effect = 0.11; 95% CI, –0.28 to 0.5 at 12 months; intervention effect = 0.03; 95% CI, –0.36 to 0.41 at 24 months), according to the study results.
Researchers reported problems with patient attendance and instructor training. Of the 180 patients in the intervention arm of the study, 84 (47%) failed to attend any modules. Seven of those had dropped out before the modules were offered at their local clinics, 11 were never offered any modules and 66 opted out, citing scheduling conflicts — although modules were scheduled to allow participants to attend school and let the clinics operate on their normal hours. The researchers also noted a “varied fidelity in delivery of content,” including untrained staff participating in one clinic’s CASCADE program, and another clinic using staff that was only partially trained in the program’s curriculum.
Christie and colleagues noted that CASCADE, along with other educational intervention programs, “each offered a single intervention to improve glycemic control, and each attempted to extend the role of existing diabetes nursing and medical staff to either deliver psychologically based interventions or deliver elements of routine care in ways informed by psychological theories such as [motivational interviewing]. Together,” the researchers wrote, “these trials suggest strongly that such approaches may be ineffective in improving diabetes control, particularly where it is already poor.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.