Psycho-educational interventions for children and young people with Type 1 Diabetes in the UK: How effective are they? A systematic review and meta-analysis

Dimitrios Charalampopoulos, Kathryn R Hesketh, Rakesh Amin, Veena Mazarello Paes, Russell M Viner, Terence Stephenson, Dimitrios Charalampopoulos, Kathryn R Hesketh, Rakesh Amin, Veena Mazarello Paes, Russell M Viner, Terence Stephenson

Abstract

Aims: To synthesise evidence from UK-based randomised trials of psycho-educational interventions in children and young people (CYP) with Type 1 Diabetes (T1D) to inform the evidence-base for adoption of such interventions into the NHS.

Methods: We searched Medline, Embase, Cochrane, PsycINFO, CINAHL, and Web of Science up to March 2016. Two reviewers independently selected UK-based randomised trials comparing psycho-educational interventions for improving management of T1D for CYP with a control group of usual care or attention control. The main outcome was glycaemic control measured by percentage of glycated haemoglobin (HbA1c); secondary outcomes included psychosocial functioning, diabetes knowledge, adverse and other clinical outcomes. A narrative synthesis and meta-analysis were conducted. Pooled effect sizes of standardised mean difference (SMD) were calculated.

Results: Ten eligible trials of three educational and seven psycho-educational interventions were identified. Most interventions were delivered by non-psychologists and targeted adolescents with more than one year duration of diabetes. Meta-analysis of nine of these trials (N = 1,838 participants) showed a non-significant reduction in HbA1c attributable to the intervention (pooled SMD = -0.06, 95% CI: -0.21 to 0.09). Psycho-educational interventions aiming to increase children's self-efficacy had a moderate, beneficial effect (SMD = 0.50, 95% CI: 0.13 to 0.87). No benefits on diabetes knowledge and other indicators of psychosocial functioning were identified.

Conclusions: There is insufficient evidence to recommend the use of particular psycho-educational programme for CYP with T1D in the UK. Further trials with sufficient power and reporting standards are needed. Future trials could consider active involvement of psychological specialists in the delivery of psychologically informed interventions and implementation of psycho-educational interventions earlier in the course of the disease.

Systematic review registration: PROSPERO CRD42015010701.

Conflict of interest statement

Competing Interests: All authors have completed the ICMJE disclosure form. TS was appointed by an independent panel to be seconded as Chair of the UK General Medical Council (GMC), commencing January 2015. Whilst answerable to Parliament rather than Government, the GMC does have a working relationship with the Department of Health (England). The grant to UCL from the Department of Health Policy Research Programme for which TS is the PI and which supported this current review preceded this appointment by 4 years. RMV was an author on one of the papers included in the systematic review (Christie et al); this has not influenced the review except to aid understanding of findings. All authors declare no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1. Flow diagram of study selection.
Fig 1. Flow diagram of study selection.
Fig 2. Outcome of risk of bias…
Fig 2. Outcome of risk of bias assessment by type of bias (Note: PEO = psycho-educational outcomes).
Fig 3. Random effects meta-analysis of change…
Fig 3. Random effects meta-analysis of change scores in HbA1c (%) in psycho-educational intervention group compared with control group.
Intervention effects calculated as Standardised Mean Difference (SMD) with 95% confidence interval. A negative effect indicates improved glycaemic control attributable to intervention.
Fig 4. Intervention effects on psychosocial outcomes…
Fig 4. Intervention effects on psychosocial outcomes calculated as Standardised Mean Difference (SMD) of change scores with 95% confidence interval.
A positive effect in quality of life, self-efficacy, and family functioning and a negative effect is psychological distress favour intervention. The diamonds show the pooled SMD based on random effects model. Notes: SED = Self-efficacy for diabetes; PedsQoL-D = Paediatric quality of life inventory: diabetes module; DQoLY = Diabetes Quality of life measure for youths (reverse scaling); PedsQoL-G = Paediatric quality of life inventory: generic scale; PAID = Problem Areas in Diabetes scale; SDQ = Strengths and difficulties Questionnaire- impact score; ECBI = Eyberg child behavior inventory; PIP = Paediatric Inventory for parents; WBQ = Well-being questionnaire (reverse scaling); DFRQ = Diabetes Family Responsibility Questionnaire (dyadic score in Christie (2014) and parental report in Murphy (2012)); DFCS = Diabetes family conflict scale; DFBS = Diabetes Family Behavior scale.

References

    1. International Diabetes Federation. Diabetes Atlas 2014. sixth edition (update):[Available from: .
    1. Kanavos P, van den Aardweg S, Schurer W. Diabetes expenditure, burden of disease and management in 5 EU countries. London School of Economics Health; 2012.
    1. Group DP. Incidence and trends of childhood Type 1 diabetes worldwide 1990–1999. Diabetic medicine: a journal of the British Diabetic Association. 2006;23(8):857–66. Epub 2006/08/17. doi: .
    1. Scottish Diabetes Survey 2013: NHS Scotland; 2014. Available from: .
    1. National Paediatric Diabetes Audit Report 2014–15: Royal College of Paediatrics and Child Health; 2016. Available from: .
    1. NICE clinical quideline: Diabetes (type 1 and type 2) in children and young people: diagnosis and management 2015. Available from: .
    1. Nathan DM, Bayless M, Cleary P, Genuth S, Gubitosi-Klug R, Lachin JM, et al. Diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: advances and contributions. Diabetes. 2013;62(12):3976–86. Epub 2013/11/23. doi: ; PubMed Central PMCID: PMC3837056.
    1. Department of Health Diabetes Policy Team. Making Every Young Person with Diabetes Matter: Report of the Children and Young People with Diabetes Working Group London2007. Available from: .
    1. Department of Health. National Service Framework for Diabetes: Delivery Strategy. London: 2003.
    1. Group DS. Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial. Bmj. 2002;325(7367):746 ; PubMed Central PMCID: PMCPMC128375.
    1. Owen C, Woodward S. Effectiveness of dose adjustment for normal eating (DAFNE). Br J Nurs. 2012;21(4):224, 6–28, 30–2. doi: .
    1. Department of Health, Diabetes UK. Structured patient education in diabetes: Report from the Patient Education Working Group. london: 2005.
    1. Hampson SE, Skinner TC, Hart J, Storey L, Gage H, Foxcroft D, et al. Effects of educational and psychosocial interventions for adolescents with diabetes mellitus: a systematic review. Health Technol Assess. 2001;5(10):1–79. .
    1. Murphy HR, Rayman G, Skinner TC. Psycho-educational interventions for children and young people with Type 1 diabetes. Diabetic medicine: a journal of the British Diabetic Association. 2006;23(9):935–43. doi: .
    1. Winkley K, Ismail K, Landau S, Eisler I. Psychological interventions to improve glycaemic control in patients with type 1 diabetes: systematic review and meta-analysis of randomised controlled trials. Bmj. 2006;333(7558):65 doi: ; PubMed Central PMCID: PMC1489251.
    1. Armour TA, Norris SL, Jack L Jr., Zhang X, Fisher L. The effectiveness of family interventions in people with diabetes mellitus: a systematic review. Diabetic medicine: a journal of the British Diabetic Association. 2005;22(10):1295–305. doi: .
    1. Howells L, Wilson AC, Skinner TC, Newton R, Morris AD, Greene SA. A randomized control trial of the effect of negotiated telephone support on glycaemic control in young people with Type 1 diabetes. Diabetic medicine. 2002;19(8):643–8. CN-00409285.
    1. Bloomfield S, Calder JE, Chisholm V, Kelnar CJ, Steel JM, Farquhar JW, et al. A project in diabetes education for children. Diabetic Medicine. 1990;7(2):137–42. doi: . Language: English. Entry Date: 20110610. Revision Date: 20120302. Publication Type: journal article.
    1. Ayling K, Brierley S, Johnson B, Heller S, Eiser C. How standard is standard care? Exploring control group outcomes in behaviour change interventions for young people with type 1 diabetes. Psychol Health. 2015;30(1):85–103. doi: ; PubMed Central PMCID: PMCPMC4270262.
    1. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. Bmj. 2009;339:b2700 doi: ; PubMed Central PMCID: PMC2714672.
    1. Centre for Reviews and Dissemination UoY. Systematic Reviews: CRD's guidance for undertaking systematic reviews in health care 2009. Available from: .
    1. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. Bmj. 2011;343:d5928 doi: ; PubMed Central PMCID: PMC3196245.
    1. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration; 2011. Available from: .
    1. Follmann D, Elliott P, Suh I, Cutler J. Variance imputation for overviews of clinical trials with continuous response. Journal of clinical epidemiology. 1992;45(7):769–73. .
    1. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Multiple Outcomes or Time-Points within a Study. Introduction to Meta-Analysis: John Wiley & Sons, Ltd; 2009. p. 225–38.
    1. Cohen J. Statistical power for the behavioural sciences: Hillsdale: Erlbaum; 1988.
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Bmj. 2003;327(7414):557–60. doi: ; PubMed Central PMCID: PMC192859.
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Statistics in medicine. 2002;21(11):1539–58. doi: .
    1. Murphy HR, Wadham C, Rayman G, Skinner TC. Approaches to integrating paediatric diabetes care and structured education: experiences from the families, adolescents, and children's teamwork study (FACTS). Diabetic Medicine. 2007;24(11):1261–8. Language: English. Entry Date: 20080418. Revision Date: 20111230. Publication Type: journal article. doi: .
    1. Murphy HR, Wadham C, Hassler-Hurst J, Rayman G, Skinner TC. Randomized trial of a diabetes self-management education and family teamwork intervention in adolescents with Type 1 diabetes. Diabetic Medicine. 2012;29(8):e249–54. doi: . Language: English. Entry Date: 20120817. Revision Date: 20140613. Publication Type: journal article.
    1. Channon SJ, Huws-Thomas MV, Rollnick S, Hood K, Cannings-John RL, Rogers C, et al. A multicenter randomized controlled trial of motivational interviewing in teenagers with diabetes. Diabetes Care. 2007;30(6):1390–5. doi: .
    1. Christie D, Thompson R, Sawtell M, Allen E, Cairns J, Smith F, et al. Structured, intensive education maximising engagement, motivation and long-term change for children and young people with diabetes: A cluster randomised controlled trial with integral process and economic evaluation—The CASCADE study. Health Technology Assessment. 2014;18(20):1–202. doi: .
    1. Coates V, Chaney D, Bunting B, Shorter G, Shevlin M, McDougall A, et al. Evaluation of the Effectiveness of a Structured Diabetes Education Programme (CHOICE) on Clinical Outcomes for Adolescents with Type 1 Diabetes: A Randomised Controlled Trial. Journal of Diabetes & Metabolism. 2013;4(6):2155–6156. doi:
    1. Doherty FM, Calam R, Sanders MR. Positive Parenting Program (Triple P) for Families of Adolescents With Type 1 Diabetes: A Randomized Controlled Trial of Self-Directed Teen Triple P. Journal of Pediatric Psychology. 2013;38(8):846–58. doi:
    1. Franklin VL, Waller A, Pagliari C, Greene SA. A randomized controlled trial of Sweet Talk, a text-messaging system to support young people with diabetes. Diabetic Medicine. 2006;23(12):1332–8. Language: English. Entry Date: 20070629. Revision Date: 20111230. Publication Type: journal article. doi: .
    1. Price KJ, Knowles JA, Fox M, Wales JKH, Heller S, Eiser C, et al. Effectiveness of the Kids in Control of Food (KICk-OFF) structured education course for 11–16 year olds with Type 1 diabetes. Diabetic Medicine. 2016;33(2):192–203. doi: .
    1. Robling M, McNamara R, Bennert K, Butler CC, Channon S, Cohen D, et al. The effect of the Talking Diabetes consulting skills intervention on glycaemic control and quality of life in children with type 1 diabetes: Cluster randomised controlled trial (DEPICTED study). BMJ (Online). 2012;344 (7860) (no pagination)(e2359). . .
    1. Robling M, McNamara R, Bennert K, Butler CC, Channon S, Cohen D, et al. The effect of the Talking Diabetes consulting skills intervention on glycaemic control and quality of life in children with type 1 diabetes: cluster randomised controlled trial (DEPICTED study). BMJ (Clinical research ed) [Internet]. 2012; 344:[e2359 p.]. Available from: .
    1. Dunn SM, Bryson JM, Hoskins PL, Alford JB, Handelsman DJ, Turtle JR. Development of the diabetes knowledge (DKN) scales: forms DKNA, DKNB, and DKNC. Diabetes Care. 1984;7(1):36–41. .
    1. Grossman HY, Brink S, Hauser ST. Self-efficacy in adolescent girls and boys with insulin-dependent diabetes mellitus. Diabetes care. 1987;10(3):324–9. .
    1. Kaufman FR, Austin J, Lloyd J, Halvorson M, Carpenter S, Pitukcheewanont P. Characteristics of glycemic control in young children with type 1 diabetes. Pediatric diabetes. 2002;3(4):179–83. Epub 2004/03/16. doi: .
    1. Anderson BJ, Wolf FM, Burkhart MT, Cornell RG, Bacon GE. Effects of peer-group intervention on metabolic control of adolescents with IDDM. Randomized outpatient study. Diabetes Care. 1989;12(3):179–83. .
    1. Mendez FJ, Belendez M. Effects of a behavioral intervention on treatment adherence and stress management in adolescents with IDDM. Diabetes Care. 1997;20(9):1370–5. .
    1. Satin W, La Greca AM, Zigo MA, Skyler JS. Diabetes in adolescence: effects of multifamily group intervention and parent simulation of diabetes. J Pediatr Psychol. 1989;14(2):259–75. .
    1. Grey M, Boland EA, Davidson M, Yu C, Sullivan-Bolyai S, Tamborlane WV. Short-term effects of coping skills training as adjunct to intensive therapy in adolescents. Diabetes Care. 1998;21(6):902–8. .
    1. Wysocki T, Harris MA, Wilkinson K, Sadler M, Mauras N, White NH. Self-management competence as a predictor of outcomes of intensive therapy or usual care in youth with type 1 diabetes. Diabetes Care. 2003;26(7):2043–7. .
    1. Alam R, Sturt J, Lall R, Winkley K. An updated meta-analysis to assess the effectiveness of psychological interventions delivered by psychological specialists and generalist clinicians on glycaemic control and on psychological status. Patient Educ Couns. 2009;75(1):25–36. doi: .
    1. Diabetes UK. Minding the gap: The provision of psychological support and care for people with diabetes in the UK: Diabetes UK; 2008. Available from: .
    1. Grey M, Boland EA, Davidson M, Li J, Tamborlane WV. Coping skills training for youth with diabetes mellitus has long-lasting effects on metabolic control and quality of life. J Pediatr. 2000;137(1):107–13. doi: .
    1. Delamater AM, Bubb J, Davis SG, Smith JA, Schmidt L, White NH, et al. Randomized prospective study of self-management training with newly diagnosed diabetic children. Diabetes Care. 1990;13(5):492–8. .
    1. Laffel LM, Vangsness L, Connell A, Goebel-Fabbri A, Butler D, Anderson BJ. Impact of ambulatory, family-focused teamwork intervention on glycemic control in youth with type 1 diabetes. J Pediatr. 2003;142(4):409–16. doi: .

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