University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
Diabet Med. 2012 Aug;29(8):e249-54. doi: 10.1111/j.1464-5491.2012.03683.x.
To evaluate the effectiveness of a family-centred group education programme, in adolescents with Type 1 diabetes.
Three hundred and five adolescents with Type 1 diabetes; age 13.1 ± 1.9 years, diabetes duration 5.6 ± 3.3 years, BMI 20.9 ± 3.7 kg/m(2) , HbA(1c) 78 ± 6 mmol/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 18 months (12 months post-intervention). Secondary outcomes were HbA(1c) at 9 months, psychosocial outcomes, adolescent quality of life, well-being, family responsibility and insulin dose adjustment behaviours at 12 months (6 months post-intervention) and episodes of severe hypoglycaemia and diabetic ketoacidois during the 12 months post-intervention. All analyses are intention to treat.
Session attendance was poor with 48/158 families (30.4%) not attending any sessions and only 75/158 (47.5%) families attending ≥ 4 group education sessions. All biomedical and psychosocial outcomes were comparable between groups. At 18 months there was no significant difference in HbA(1c) in either group and no between-group differences over time: intervention group 75 mmol/mol (9.0%) to 78 mmol/mol (9.3%), control group 77 mmol/mol (9.2%) to 80 mmol/mol (9.5%). Adolescents perceived no changes in parental input at 12 months.
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.
评估以家庭为中心的团体教育计划对 1 型糖尿病青少年的疗效。
将 305 例 13.1 ± 1.9 岁、糖尿病病程 5.6 ± 3.3 年、BMI 20.9 ± 3.7 kg/m²、HbA1c 78 ± 6 mmol/mol（9.3 ± 1.9%）的 1 型糖尿病青少年随机分配至 Families and Adolescents Communication and Teamwork Study（FACTS）糖尿病教育计划组（6 次每月 90 分钟的家长和青少年参加的课程，包括技能培训和家庭团队合作）或常规临床护理组。主要结局为 18 个月时的 HbA1c（干预后 12 个月）。次要结局为 9 个月时的 HbA1c、心理社会结局、青少年生活质量、幸福感、家庭责任感和 12 个月时的胰岛素剂量调整行为（干预后 6 个月）以及干预后 12 个月内严重低血糖和糖尿病酮症酸中毒的发作次数。所有分析均为意向治疗。
由于出席率低，只有 48/158 个家庭（30.4%）未参加任何课程，只有 75/158 个家庭（47.5%）参加了≥4 次团体教育课程。两组间所有生物医学和心理社会结局均无差异。18 个月时，两组间 HbA1c 无显著差异，且组间无时间差异：干预组 75 mmol/mol（9.0%）至 78 mmol/mol（9.3%），对照组 77 mmol/mol（9.2%）至 80 mmol/mol（9.5%）。12 个月时，青少年感知到父母的投入没有变化。
在常规诊所进行的团体教育课程出席率低是一个主要挑战。可能需要更个性化的教育方法来支持和激励那些努力将强化胰岛素治疗方案的需求融入日常生活的家庭。
