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Randomized prospective study of self-management training with newly diagnosed diabetic children
A M Delamater1, J Bubb, S G Davis
1Wayne State University, Detroit, MI 48202.
Insights
Self-management training (SMT) improved metabolic control in children with insulin-dependent diabetes mellitus (IDDM). This program helped maintain lower HbA1 levels, preventing deterioration often seen after diagnosis.
Area of Science:
- Pediatrics
- Endocrinology
- Metabolic Disorders
Background:
- Pediatric insulin-dependent diabetes mellitus (IDDM) management requires effective long-term strategies.
- Metabolic control often deteriorates in children with IDDM between 6 and 24 months post-diagnosis.
- Self-monitoring of blood glucose (SMBG) is a key component in diabetes management.
Purpose of the Study:
- To evaluate the impact of a self-management training (SMT) program on metabolic control in children with IDDM.
- To assess if SMT can prevent the common deterioration of metabolic control in the first two years after diagnosis.
- To compare SMT with conventional follow-up and supportive counseling (SC).
Main Methods:
- A randomized controlled trial involving 36 children newly diagnosed with IDDM (mean age 9.3 years).
- Interventions included standard diabetes education, supportive counseling (SC), and self-management training (SMT) emphasizing SMBG.
- Metabolic control was assessed quarterly using glycosylated hemoglobin (HbA1) over two years post-diagnosis.
Main Results:
- All groups showed initial improvement in HbA1 within the first 6 months.
- SMT patients demonstrated significantly lower HbA1 levels at 1 and 2 years compared to conventional follow-up.
- While SMT patients had lower HbA1 than SC patients, this difference was not statistically significant.
Conclusions:
- Self-management training (SMT) initiated early after diagnosis can significantly improve and maintain metabolic control in children with IDDM.
- SMT appears effective in preventing the typical decline in metabolic control observed between 6 and 24 months post-diagnosis.
- Early implementation of SMT is a valuable strategy for pediatric IDDM management.
Abstract:
This study was designed to evaluate the effects of a self-management training (SMT) program on metabolic control of children with insulin-dependent diabetes mellitus (IDDM) in the first 2 yr after diagnosis. After standard in-hospital diabetes education, 36 children (mean age 9.3 yr, range 3-16 yr) were randomized to conventional follow-up, conventional and supportive counseling (SC), or conventional and SMT, which emphasized use of data obtained from self-monitoring of blood glucose. SC and SMT interventions consisted of seven outpatient sessions with a medical social worker during the first 4 mo after diagnosis and booster sessions at 6 and 12 mo postdiagnosis. Groups were similar with respect to age, sex, body mass index, socioeconomic status, C-peptide, and severity of illness at diagnosis. Metabolic control, measured quarterly by glycosylated hemoglobin (HbA1), improved substantially in all three treatment groups during the first 6 mo. SMT patients had significantly lower HbA1 levels than conventional patients at 1 yr (P less than 0.01) and 2 yr (P less than 0.05) postdiagnosis. SMT patients also had lower HbA1 levels than SC patients, but this did not reach statistical significance. The lower HbA1 levels of SMT patients were not explained by severity of illness at diagnosis, or insulin dose, body mass index, and C-peptide levels at 2 yr. These results suggest that an SMT program during the first few months after diagnosis helps avoid the deterioration in metabolic control often seen in children with IDDM between 6 and 24 mo after diagnosis.