Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona.
Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona.
Endocr Pract. 2022 Nov;28(11):1146-1151. doi: 10.1016/j.eprac.2022.07.015. Epub 2022 Aug 9.
To evaluate the feasibility, acceptability, and preliminary efficacy of a team-based intervention for youth with type 1 diabetes (T1D) with suboptimal glycemia, as detected based on the measurement of hemoglobin A1C (HbA1C).
Forty participants with T1D for >1 year and an HbA1C level of ≥9.5% (80 mmol/mol) enrolled for a multidisciplinary intervention that included pediatric endocrinologists, pediatric psychologists, and a certified diabetes care and education specialist (CDCES). The CDCES-integrated medical management, while reinforcing physical, emotional, and behavioral health, connected with families to set and monitor goals and reviewed medication adjustments. The feasibility was assessed based on enrollment targets; acceptability based on retention rates; and preliminary efficacy based on changes in HbA1C levels, quality of life, diabetes-related strengths and resilience, hospital admissions, emergency room visits, and missed school days.
Of 43 patients and families approached, 40 agreed to participate, 36 completed the 4-month intervention, and 31 completed full 8 months of follow-up data collection. The CDCES coach averaged 6.8 contacts per participant during the 8-month study period. The HbA1C level reduced significantly from baseline to 4 months (12.1% ± 1.6% to 11.0% ± 1.9%, P = .001) and was sustained at 8 months (10.7% ± 1.9%, P < .001). The participants reported significant increases in diabetes-specific quality of life (P < .05) and diabetes-related strength and resilience (P = .003). The missed school days reduced from 7.23 ± 7.5 days to 1.55 ± 1.9 days (P < .001), and the diabetes-related hospitalizations decreased from 0.4 ± 0.6 to 0.1 ± 0.3 (P = .009).
Preliminary data suggest that a multidisciplinary intervention leveraging a team-based approach with a physician, psychologist, and CDCES can support improvements in glycemic control and psychosocial outcomes among youth with T1D with an HbA1C level above the target.
评估基于糖化血红蛋白 (HbA1C) 测量结果发现血糖控制不佳的 1 型糖尿病 (T1D) 青少年的团队为基础的干预措施的可行性、可接受性和初步疗效。
40 名患有 T1D 超过 1 年且 HbA1C 水平≥9.5%（80mmol/mol）的参与者参加了多学科干预，该干预包括儿科内分泌学家、儿科心理学家和认证的糖尿病护理和教育专家 (CDCES)。CDCES 整合的医疗管理在加强身体、情感和行为健康的同时，与家庭合作设定和监测目标，并审查药物调整。可行性根据入组目标进行评估；可接受性根据保留率进行评估；初步疗效根据 HbA1C 水平、生活质量、与糖尿病相关的优势和适应力、住院、急诊就诊和缺课天数的变化进行评估。
在接触的 43 名患者及其家属中，有 40 名同意参与，36 名完成了 4 个月的干预，31 名完成了完整的 8 个月随访数据收集。在 8 个月的研究期间，CDCES 教练平均每个参与者有 6.8 次接触。HbA1C 水平从基线到 4 个月显著降低（12.1%±1.6%至 11.0%±1.9%，P=0.001），并在 8 个月时保持稳定（10.7%±1.9%，P<0.001）。参与者报告称，糖尿病特异性生活质量（P<0.05）和与糖尿病相关的优势和适应力（P=0.003）显著增加。缺课天数从 7.23±7.5 天减少到 1.55±1.9 天（P<0.001），与糖尿病相关的住院次数从 0.4±0.6 减少到 0.1±0.3（P=0.009）。
初步数据表明，一种多学科干预措施利用基于团队的方法，由医生、心理学家和 CDEC 共同参与，可以支持 HbA1C 水平高于目标的 T1D 青少年改善血糖控制和心理社会结局。
