Waller H, Eiser C, Knowles J, Rogers N, Wharmby S, Heller S, Hall C, Greenhalgh S, Tinklin T, Metcalfe C, Millard E, Parkin V, Denial M, Price K
Department of Psychology, University of Sheffield, Sheffield, UK.
Arch Dis Child. 2008 Nov;93(11):927-31. doi: 10.1136/adc.2007.132126. Epub 2008 Aug 1.
To pilot an educational programme (KICk-OFF) for children and adolescents with type 1 diabetes mellitus (DM). Evaluation included (i) independent assessment of curriculum quality, (ii) acceptability to families and (iii) possible impact on standardised outcome measures (HbA1c, body mass index (BMI), diary reports of hypoglycaemia, quality of life (QoL)).
48 children aged 11-16 years (mean age 13.60 (SD 1.36) years) were recruited from three UK centres. Six 5-day outpatient courses on carbohydrate counting and insulin dose adjustment were held. Semi-structured interviews were conducted with children and parents before and after the course. Glycaemic control (HbA1c), BMI and frequency of hypoglycaemia were assessed before the course and at 3 and 6 months after intervention. QoL was assessed before the course and at 2 weeks, 3 and 6 months.
Educational evaluation indicated the course format was appropriate and consistent. Parent and child interviews suggested that pre-course expectations were largely met. There were no changes in HbA1c, BMI or episodes of hypoglycaemia, but children and parents reported improved QoL (p<0.05).
KICk-OFF was well-received by children and parents and was associated with improved QoL. In this small pilot study, glycaemic control did not change but findings justify conducting a future randomised controlled trial involving a revised curriculum, a larger study population including a control group and longer follow-up.
为1型糖尿病(DM)儿童和青少年试行一项教育计划(KICk - OFF)。评估内容包括:(i)对课程质量的独立评估;(ii)家庭接受度;(iii)对标准化结果指标(糖化血红蛋白(HbA1c)、体重指数(BMI)、低血糖日记报告、生活质量(QoL))的可能影响。
从英国三个中心招募了48名11 - 16岁的儿童(平均年龄13.60(标准差1.36)岁)。举办了六期为期5天的关于碳水化合物计数和胰岛素剂量调整的门诊课程。在课程前后对儿童和家长进行了半结构化访谈。在课程开始前以及干预后3个月和6个月评估血糖控制情况(HbA1c)、BMI和低血糖发生频率。在课程开始前以及2周、3个月和6个月评估生活质量。
教育评估表明课程形式合适且连贯。家长和儿童访谈表明课程前的期望基本得到满足。HbA1c、BMI或低血糖发作次数没有变化,但儿童和家长报告生活质量有所改善(p<0.05)。
KICk - OFF受到儿童和家长的好评,并与生活质量改善相关。在这项小型试点研究中,血糖控制没有改变,但研究结果证明有必要开展一项未来的随机对照试验,该试验涉及修订后的课程、包括对照组在内的更大研究人群以及更长的随访时间。