Management of Type 1 diabetes in adolescents: Effectiveness of the remote personalized system of instruction model

Type 1 Diabetes Mellitus (T1DM) is a common chronic condition in childhood and requires appropriate education and self-management skills. Structured education is key to improving glycemic stability and empowering adolescents. The Personalized System of Instruction (PSI), though effective in other fields, is underused in diabetes education. This study evaluated the impact of PSI-based structured ongoing education program among adolescents living with T1DM and with glycemic instability.

A randomized controlled trial with a pre-test/post-test comparison group design was conducted. Participants were adolescents aged 12-18 years with glycemic instability (glycated hemoglobin [HbA1c] ≥7%) and at least one weekly hypo-hyperglycemic episode. Stratified randomization ensured group balance. The study included 60 adolescents with T1DM, evenly split between intervention and control groups. Validated instruments were used to assess cognitive knowledge, self-efficacy, glycemic episode frequency, and HbA1c levels. The intervention group received structured education based on the PSI model, while the comparison group received standard diabetes education.

The intervention group showed significantly greater improvements than the comparison group in all outcomes. From the 3rd month, cognitive knowledge and self-efficacy increased, while HbA1c levels and glycemic episode frequency declined. Group-time interaction was significant, with sustained improvement in the PSI group up to 6 months. η² values indicated moderate to large effect sizes.

The PSI model is an effective strategy to enhance diabetes self-management and glycemic stability in adolescents with T1DM. Its structured, learner-centered design offers a promising alternative to traditional education methods in this population.

The findings suggest that the PSI framework can be effectively integrated into pediatric nursing practice to support individualized, learner-centered diabetes self-management education for adolescents with T1DM, enhance skill acquisition and self-efficacy, and facilitate ongoing educational support within both in-person and digital care settings.