Individualised diabetes education for adolescents: A pilot study

A decline in metabolic control is often observed during puberty in type 1 diabetes. Factors such as the physical, emotional and psychosocial maturity process affect insulin requirement and self-monitoring of blood glucose, which can be challenging for the whole family (Court et al, 2009). The ISPAD consensus guidelines in 2009 state that diabetes education should be “adaptable, personalized, appropriate to each individual’s age, stage of diabetes…  and at a pace to suit individual needs” (Swift, 2009).

The purpose of this pilot study was to assess the effectiveness of age-appropriate individual diabetes education training (IDET) encouraging adolescents with type 1 diabetes “to become independent” (TBI) and providing “motivational education” (ME) in reaching optimal control. The training comprised at least four “one-to-one” 1-hour sessions.

TBI training was prepared for individuals aged 10–14 years as a prevention against declining metabolic control in late adolescence. It aims to enhance skills and knowledge in diabetes management, encourage greater independence and self-confidence in decision-making, and allow participation in activities such as school trips without carers. ME training was conducted for those aged 15–18 years, focusing on motivation rather than increasing knowledge. It aims to recognise the problems affecting diabetes management, respond to these problems and clarify why solving them is important, with a focus on individual needs and capabilities.

Results
In the whole study-group (see Table 1 for group characteristics), diabetes education programmes significantly decreased HbA_1c levels (3.2 ± 11.5 mmol/mol [−0.29 ± 1.05%]), compared with adolescents with no diabetes education (0.5 ± 6.4 mmol/mol [0.05 ± 0.59%, P<0.05]). The greatest decrease in HbA_1c (5.1 ± 12.8 mmol/mol [−0.47 ± 1.17%, P<0.001]) was observed in those who received structured IDET training, and the HbA_1c decreased by more than 10.9 mmol/mol (1%) in 14 IDET participants. A linear regression model was estimated, revealing that a lack of diabetes education was a strong predictor of an increase in HbA_1c levels (P<0.05; see Figure 1).

Conclusions
Participation in IDET, particularly increased educational support and visits to the clinic, was associated with improvement in HbA_1c levels. ME was associated with the most marked improvement in HbA_1c, and long-term observation over 2–4 years is required to confirm the efficacy of TBI training owing to its preventative style. The authors note that other parameters may be useful to assess the effectiveness of diabetes programmes, such as the prevalence of diabetic ketoacidosis.

For further information on the education programmes, email katarzyna.gajewska@imid.med.pl.