Christie, D;
Thompson, R;
Sawtell, M;
Allen, E;
Cairns, J;
Smith, F;
Jamieson, E;
... Viner, RM; + view all
(2016)
Effectiveness of a structured educational intervention using psychological delivery methods in children and adolescents with poorly controlled type 1 diabetes: a cluster randomised controlled trial of the CASCADE intervention.
BMJ Open Diabetes Research & Care
, 4
(1)
, Article e000165. 10.1136/bmjdrc-2015-000165.
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Abstract
Introduction: Type 1 diabetes in children and adolescents is increasing worldwide with a particular increase in children < 5 years. Fewer than one in six children and adolescents achieve recommended HbA1c values. Methods: A pragmatic, cluster randomised control trial assessed the efficacy of a clinic-based structured educational group incorporating psychological approaches to improve long-term glycaemic control, quality of life and psychosocial functioning in children and adolescents with T1D. 28 paediatric diabetes services were randomised to deliver the intervention or standard care. 362 children (8-16 years) HbA1c ≥ 8.5% were recruited. Outcomes were HbA1c at 12 and 24 months, hypoglycaemia, admissions, self-management skills, intervention compliance, emotional and behavioural adjustment and quality of life. A process evaluation collected data from key stakeholder groups in order to evaluate the feasibility of delivering the intervention. Results: 298/362 patients (82.3%) provided HbA1c at 12 months and 284/362 (78.5%) at 24 months. The intervention did not improve HbA1c at 12 months (intervention effect 0.11, 95% CI −0.28 to 0.50, P=0.584), or 24 months (intervention effect 0.03, 95% CI -0.36 to 0.41, P=0.891). There were no significant changes in remaining outcomes. 96/180 (53%) families in the intervention arm attended at least one module. The number of modules attended did not affect outcome. Reasons for low uptake included difficulties organising groups and work and school commitments. Those with highest HbA1cs were less likely to attend. Mean cost of the intervention was £683 per child. Conclusions: Significant challenges in the delivery of a structured education intervention using psychological techniques to enhance engagement and behaviour change delivered by diabetes nurses and dietitians in routine clinical practice were found. The intervention did not improve HbA1c in children and adolescents with poor control.
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