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A structured 1-year education program for children with newly diagnosed type 1 diabetes improves early glycemic
Colin P Hawkes1,2, Steven M Willi1,2, Kathryn M Murphy1
1Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
A certified diabetes educator-led program improved short-term hemoglobin A1c (HbA1c) in children with type 1 diabetes (T1D). However, benefits diminished over time and were not seen in families with lower socioeconomic status (SES).
Area of Science:
- Pediatric Endocrinology
- Diabetes Management
- Public Health
Background:
- Type 1 diabetes (T1D) diagnosis presents multifaceted challenges for children, families, and healthcare teams.
- A structured program led by certified diabetes educators (CDEs) was developed to support families during the first year post-diagnosis.
- The program aimed to enhance understanding and management of this chronic condition.
Purpose of the Study:
- To evaluate the impact of a CDE-led program on hemoglobin A1c (HbA1c) levels in children with T1D.
- To investigate whether socioeconomic status (SES) influences the program's effectiveness on HbA1c control.
Main Methods:
- A type 1 diabetes year 1 (T1Y1) program assigned a CDE for intensive, tailored coaching to families.
- Patients diagnosed with T1D in the two years prior (controls) and after (T1Y1 group) the program's start were identified.
- HbA1c levels were compared between groups at 6, 12, 18, and 24 months post-diagnosis.
Main Results:
- The T1Y1 group showed significantly lower HbA1c at 6, 12, and 18 months compared to controls.
- HbA1c improvements were not sustained at 24 months post-diagnosis.
- Patients from lower socioeconomic status (SES) backgrounds did not experience similar benefits.
Conclusions:
- Structured, intensive diabetes education and support in the first year post-T1D diagnosis can yield short-term improvements in glycemic control.
- The positive effects on HbA1c may not persist after the cessation of intensive coaching.
- Current program strategies do not effectively benefit families with lower SES, highlighting a need for tailored interventions.
Background:
The diagnosis of type 1 diabetes (T1D) brings significant medical, psychosocial, and educational challenges for the child, family, and medical team. We developed a structured certified diabetes educator (CDE) led program spanning the year after diagnosis with the goal of supporting families as their understanding of this chronic disease and its management evolves.
Objective:
The aim of this study was to determine the effect of this program upon hemoglobin A1c (HbA1c), and how this effect is mitigated by socioeconomic status (SES).
Methods:
Patients enrolled in the type 1 year 1 (T1Y1) program were assigned a CDE who provided intensive coaching, tailored to family lifestyle, and readiness to assume independence. We identified all patients diagnosed with T1D in the 2 years before (controls) and after (T1Y1 group) the start of the T1Y1 program on January 7, 2014.
Results:
There were 675 patients diagnosed with T1D between July 2012 and June 2016 (284 controls, 391 T1Y1). HbA1c was significantly lower in the T1Y1 group at 6 (6.7% vs. 7.1%, P < 0.001), 12 (7.3% vs. 7.8%, P < 0.001) and 18 (7.6% vs. 7.9%, P = 0.01) months, but not 24 (7.8% vs. 8%, P = 0.14) months after diagnosis. This effect was not observed in patients with lower SES.
Conclusion:
Additional structured education and support in the year after diagnosis can improve short-term outcomes in children with T1D, but this effect may not persist after discontinuing intensive coaching. Families of lower SES did not benefit from this approach.
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