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Diabetes Education for Children With Type 1 Diabetes Mellitus and Their Families
Evidence Reports/Technology Assessments, No. 166
Investigators: Robert Couch, MS, MD, FRCPC, Mary Jetha, MD, FRCPC, Donna M Dryden, PhD, Nicola Hooton, BSc, MPH, Yuanyuan Liang, PhD, Tamara Durec, BSc (Pharm), MLIS, Elizabeth Sumamo, BSc, MPH, Carol Spooner, BScN, MS, Andrea Milne, BScN, Kate O'Gorman, BSc, and Terry P Klassen, MD, MS, FRCPC.
Structured Abstract
Objectives:
To determine the effectiveness of diabetes education on metabolic control, diabetes-related hospitalizations, complications, and knowledge, quality of life and other psychosocial outcomes for children with type 1 diabetes and their families.
Data Sources:
A systematic and comprehensive literature review was conducted in 21 electronic databases of medical and health education literature to identify randomized controlled trials (RCTs) and observational studies evaluating the effectiveness of diabetes education.
Review Methods:
Study selection, quality assessment, and data extraction were conducted independently by several investigators in duplicate. A descriptive analysis is presented.
Results:
From 12,756 citations, 80 studies were identified and included in the review (53 RCTs or CCTs, 27 observational studies). The methodological quality of studies was generally low.
Most studies (35/52) that examined the effect of educational interventions on HbA1c found no evidence of increased effectiveness of the interventions over the education provided as part of standard care. Successful interventions were heterogeneous and included cognitive behavioral therapy, family therapy, skills training and general diabetes education. Most studies reported a positive effect on health service utilization (i.e., reduced use), although less than half were statistically significant. There was no clear evidence that educational interventions had an effect on short-term complications.
The effect of educational interventions on diabetes knowledge was unclear with 12/30 studies reporting a significant improvement. Interventions which had varying effects on knowledge scores included diabetes camp, general diabetes education, and cognitive behavioral therapy. In the area of self management/regimen adherence, 10/21 studies reported improving this outcome significantly. Successful interventions included general diabetes education and cognitive behavioral therapy. Educational interventions were successful in improving various psychosocial outcomes.
The results of two studies examining refinements to intensive therapy education suggest that educational interventions may enhance the effects of intensive diabetes management in reducing HbA1c.
Conclusions:
Due to the heterogeneity of reported diabetes education interventions, outcome measures, and duration of followup, there is insufficient evidence to identify a particular intervention that is more effective than standard care to improve diabetes control or quality of life or to reduce short-term complications.
Contents
- Preface
- Acknowledgments
- Executive Summary
- 1. Introduction
- 2. Methods
- 3. Results
- Literature Search
- Description of Included Studies
- Methodological Quality of Included Studies
- Results of Included Studies
- HbA1c
- Health Services Utilization
- Complications
- Knowledge
- Skills Training—Knowledge
- Skills
- Self-Management/Adherence
- Psychosocial Outcomes
- Summary of Results—Self-perception
- Stress
- Quality of Life
- School Performance
- 4. Discussion
- Appendixes
- References and Included Studies
Suggested citation:
Couch R, Jetha M, Dryden DM, Hooton N, Liang Y, Durec T, Sumamo E, Spooner C, Milne A, O'Gorman K, Klassen TP. Diabetes Education for Children With Type 1 Diabetes Mellitus and Their Families. Evidence Report/Technology Assessment No. 166. (Prepared by the University of Alberta/Capital Health Evidence-based Practice Center under Contract No. 290-02-0023.) AHRQ Publication No. 08-E011. Rockville, MD: Agency for Healthcare Research and Quality. April 2008.
This report is based on research conducted by the University of Alberta/Capital Health Evidence-based Practice Center (EPC), Edmonton, AB, Canada, under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0023). The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.
This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in this report.
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- Psychological interventions to improve self-management of type 1 and type 2 diabetes: a systematic review.[Health Technol Assess. 2020]Psychological interventions to improve self-management of type 1 and type 2 diabetes: a systematic review.Winkley K, Upsher R, Stahl D, Pollard D, Kasera A, Brennan A, Heller S, Ismail K. Health Technol Assess. 2020 Jun; 24(28):1-232.
- Structured, intensive education maximising engagement, motivation and long-term change for children and young people with diabetes: a cluster randomised controlled trial with integral process and economic evaluation - the CASCADE study.[Health Technol Assess. 2014]Structured, intensive education maximising engagement, motivation and long-term change for children and young people with diabetes: a cluster randomised controlled trial with integral process and economic evaluation - the CASCADE study.Christie D, Thompson R, Sawtell M, Allen E, Cairns J, Smith F, Jamieson E, Hargreaves K, Ingold A, Brooks L, et al. Health Technol Assess. 2014 Mar; 18(20):1-202.
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- Review Interventions to improve patients' compliance with therapies aimed at lowering glycated hemoglobin (HbA1c) in type 1 diabetes: systematic review and meta-analyses of randomized controlled clinical trials of psychological, telecare, and educational interventions.[Trials. 2016]Review Interventions to improve patients' compliance with therapies aimed at lowering glycated hemoglobin (HbA1c) in type 1 diabetes: systematic review and meta-analyses of randomized controlled clinical trials of psychological, telecare, and educational interventions.Viana LV, Gomes MB, Zajdenverg L, Pavin EJ, Azevedo MJ, Brazilian Type 1 Diabetes Study Group. Trials. 2016 Feb 17; 17:94. Epub 2016 Feb 17.
- Review Treatment of periodontal disease for glycaemic control in people with diabetes mellitus.[Cochrane Database Syst Rev. 2015]Review Treatment of periodontal disease for glycaemic control in people with diabetes mellitus.Simpson TC, Weldon JC, Worthington HV, Needleman I, Wild SH, Moles DR, Stevenson B, Furness S, Iheozor-Ejiofor Z. Cochrane Database Syst Rev. 2015 Nov 6; 2015(11):CD004714. Epub 2015 Nov 6.
- Diabetes Education for Children With Type 1 Diabetes Mellitus and Their FamiliesDiabetes Education for Children With Type 1 Diabetes Mellitus and Their Families
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