Interventions with adherence-promoting components in pediatric type 1 diabetes: meta-analysis of their impact on glycemic control.
OBJECTIVE
To review interventions with adherence-promoting components and document their impact on glycemic control via meta-analysis.


METHODS
Data from 15 studies that met the following criteria were subjected to meta-analysis: 1) randomized, controlled trial, 2) study sample included youth aged <19 years, 3) youth had type 1 diabetes, 4) study reported results on glycemic control; and 5) study reported use of adherence- or self-management-promoting components.


RESULTS
The 15 studies included 997 youth with type 1 diabetes. The mean effect size for pre- to posttreatment change for the intervention versus control group comparison was 0.11 (95% CI -0.01 to 0.23). This is a small effect, demonstrating very modest improvements in glycemic control. However, analysis for the pre- to posttreatment effects for the intervention group alone did show significant variability [Q(14) = 33.11; P < 0.05]. Multicomponent interventions, those that targeted emotional, social, or family processes that facilitate diabetes management, were more potent than interventions just targeting a direct, behavioral process (e.g., increase in blood glucose monitoring frequency).


CONCLUSIONS
Interventions that focus on direct, behavioral processes and neglect emotional, social, and family processes are unlikely to have an impact on glycemic control; multicomponent interventions showed more robust effects on A1C. Future clinical research should focus on refining interventions and gathering more efficacy and effectiveness data on health outcomes of the pediatric patients treated with these interventions.
Hood
Korey K
KK
Department of Pediatrics, University of Cincinnati College of Medicine, Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati, Ohio, USA. korey.hood@cchmc.org.
Rohan
Jennifer M
JM
Peterson
Claire M
CM
Drotar
Dennis
D
D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000523:psychology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D055118:Medication Adherence; D012648:Self Care; D012944:Social Support
D007004:Hypoglycemic Agents; D007328:Insulin