PETS-D: Impact on Diabetes Management Outcomes
Susan Sullivan-Bolyai1, Sybil Crawford2, Carol Bova2
1New York University College of Nursing, New York, New York (Dr Sullivan-Bolyai, Ms Ramchandani, Dr Fletcher, Dr Melkus)
Insights
Human patient simulation (HPS) improved diabetes management for parents of younger children with type 1 diabetes, showing benefits in A1C, anxiety, and hypoglycemia fear. This approach enhances parental confidence and awareness in managing their child's condition.
Area of Science:
- Pediatric Endocrinology
- Medical Simulation
- Diabetes Management
Background:
- Type 1 diabetes diagnosis in children requires comprehensive parental education.
- Traditional parent education methods may have limitations in engagement and knowledge retention.
- Human patient simulation (HPS) offers a novel approach to enhance diabetes education for parents.
Purpose of the Study:
- To evaluate the efficacy of Parent Education Through Simulation-Diabetes (PETS-D) using HPS.
- To compare HPS-based education with standard vignette-only education for parents of children newly diagnosed with type 1 diabetes.
- To assess impacts on diabetes knowledge, problem-solving, hypoglycemia fear, anxiety, and self-efficacy.
Main Methods:
- Randomized controlled trial comparing HPS with vignette-only parent education.
- 191 parents of children with type 1 diabetes were recruited.
- Outcomes were assessed at 2, 6, and 14 weeks using linear mixed modeling, with subgroup analyses by child's age and parent education level.
Main Results:
- HPS showed a statistically significant benefit for parents of younger children (<6 years old).
- Parents of younger children in the HPS group had lower A1C (8.16% vs 9.48%), lower state anxiety (P = .0094), and higher fear of hypoglycemia (P = .03).
- Overall treatment differences were modest, potentially due to outcome measure limitations.
Conclusions:
- HPS-based diabetes education is particularly beneficial for parents of younger children newly diagnosed with type 1 diabetes.
- The intervention may increase parental comfort and awareness, leading to improved glycemic control (A1C) in younger children.
- Future research should explore HPS efficacy further, especially in very young children.
Objective:
To evaluate the efficacy of Parent Education Through Simulation-Diabetes (PETS-D; clinical trial registration NCT01517269) for parents of children <13 years old newly diagnosed with type 1 diabetes with 3 parent education vignette sessions using human patient simulation (HPS) as compared with formal parent-nurse education sessions (vignette only) regarding diabetes knowledge, problem-solving skills, hypoglycemia fear, anxiety, and self-efficacy.
Design And Methods:
Subjects were randomized to the HPS parent diabetes education or the vignette-only arm. Using linear mixed modeling, we compared HPS and vignette-only groups at 2, 6, and 14 weeks. Effect modification of treatment by dichotomized child's age (<6 and ≥ 6 years old) and parent education (≤ high school and >high school) was also tested. All analyses were intent to treat and adjusted for baseline outcome level and clustering within site.
Results:
We recruited 191 parents (116 children). Mean baseline A1C was 12%. Overall treatment-related differences were modest. There was a statistically significant effect modification of HPS by child's age, with a larger HPS benefit among parents of younger children for several outcomes: A1C (8.16% vs 9.48% in control; P = .006), lower state anxiety (P = .0094), and higher fear of hypoglycemia (P = .03) for parents of children <6 years old in the HPS group.
Conclusions:
Modest treatment-related differences may reflect ceiling/floor effects in many of the outcomes; we also compared HPS with another intervention rather than to usual education. Parents of younger children receiving the intervention may feel more comfortable with lower A1C levels because of management awareness gleaned from the HPS experience. Future research will include a retrospective case-control study of very young children.
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