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Standardised self-management kits for children with type 1 diabetes: pragmatic randomised trial of effectiveness and

Jane Noyes1, Davina Allen2, Cynthia Carter3

  • 1School of Health Sciences, Bangor University, Bangor, UK jane.noyes@bangor.ac.uk.

BMJ Open
|March 15, 2020
PubMed

Insights

Standardised self-management kits for children with type 1 diabetes did not improve glycaemic control or quality of life. The kits were associated with increased worry and poor adherence, indicating a need for new management strategies.

Area of Science:

  • Pediatric Endocrinology
  • Diabetes Self-Management
  • Clinical Trial Methodology

Background:

  • Type 1 diabetes requires lifelong self-management, posing challenges for pediatric patients.
  • Empowering children with diabetes through self-management tools is a key therapeutic goal.

Purpose of the Study:

  • To evaluate the effectiveness of standardized self-management kits in improving glycaemic control and quality of life for children with type 1 diabetes.
  • To assess the impact of these kits on patient-reported outcomes and adherence.

Main Methods:

  • A pragmatic trial with a 2:1 intervention-to-control randomization ratio was conducted across 11 UK diabetes clinics.
  • 308 children (aged 6-18 years) were randomized, with 201 receiving the intervention kits.
  • Outcomes measured at 3 and 6 months included the Diabetes Pediatric Quality of Life Inventory (PedsQL) and HbA1c levels.

Main Results:

  • Self-management kits did not demonstrate significant benefits in glycaemic control (HbA1c) or overall quality of life.
  • While 'Worry' scores improved initially, 'Treatment Adherence' worsened at 6 months, and PedsQL scores declined.
  • Kit utilization was low, with limited perceived association between glucose monitoring and improved control; kits were also found to be alienating.

Conclusions:

  • Standardized self-management kits for pediatric type 1 diabetes showed no evidence of benefit and potentially hindered self-management, increasing patient worry.
  • Future research should focus on the child-professional relationship and novel approaches to diabetes management support.
  • The study highlights the need for more effective and less alienating tools for pediatric diabetes self-care.
Abstract

Keywords:
health economicshealth services administration & managementpaediatric endocrinology

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