Randomized trial of a diabetes self-management education and family teamwork intervention in adolescents with Type1 diabetes

Aims To evaluate the effectiveness of a family-centred group education programme, in adolescents with Type1 diabetes. Methods Three hundred and five adolescents with Type1 diabetes; age 13.1±1.9years, diabetes duration 5.6±3.3years, BMI 20.9±3.7kg/m 2, HbA 1c 78±6mmol/mol (9.3±1.9%) were randomly allocated to the Families and Adolescents Communication and Teamwork Study (FACTS) diabetes education programme; (six 90-min monthly sessions attended by parents and adolescents incorporating skills training and family teamwork) or conventional clinical care. Primary outcome was HbA 1c at 18months (12months post-intervention). Secondary outcomes were HbA 1c at 9months, psychosocial outcomes, adolescent quality of life, well-being, family responsibility and insulin dose adjustment behaviours at 12months (6months post-intervention) and episodes of severe hypoglycaemia and diabetic ketoacidois during the 12months post-intervention. All analyses are intention to treat. Results Session attendance was poor with 48/158 families (30.4%) not attending any sessions and only 75/158 (47.5%) families attending ≥4group education sessions. All biomedical and psychosocial outcomes were comparable between groups. At 18months there was no significant difference in HbA 1c in either group and no between-group differences over time: intervention group 75mmol/mol (9.0%) to 78mmol/mol (9.3%), control group 77mmol/mol (9.2%) to 80mmol/mol (9.5%). Adolescents perceived no changes in parental input at 12months. Conclusion Poor attendance of group education sessions delivered in routine clinics was a major challenge. More personalized educational approaches may be required to support and motivate families who are struggling to integrate the demands of intensive insulin regimens into their daily lives. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.