title: Improving glycaemic control and life skills in adolescents with type 1 diabetes: a randomised, controlled intervention study using the Guided Self-Determination-Young method in triads of adolescents, parents and health care providers integrated into routine paediatric outpatient clinics.
abstract: BACKGROUND
  Adolescents with type 1 diabetes face demanding challenges due to conflicting priorities between psychosocial needs and diabetes management. This conflict often results in poor glycaemic control and discord between adolescents and parents. Adolescent-parent conflicts are thus a barrier for health care providers (HCPs) to overcome in their attempts to involve both adolescents and parents in improvement of glycaemic control. Evidence-based interventions that involve all three parties (i.e., adolescents, parents and HCPs) and are integrated into routine outpatient clinic visits are lacking. The Guided Self-Determination method is proven effective in adult care and has been adapted to adolescents and parents (Guided Self-Determination-Young (GSD-Y)) for use in paediatric diabetes outpatient clinics. Our objective is to test whether GSD-Y used in routine paediatric outpatient clinic visits will reduce haemoglobin A1c (HbA1c) concentrations and improve adolescents' life skills compared with a control group.
  
  
  METHODS
  Using a mixed methods design comprising a randomised controlled trial and a nested qualitative evaluation, we will recruit 68 adolescents age 13-18 years with type 1 diabetes (HbA1c > 8.0%) and their parents from 2 Danish hospitals and randomise into GSD-Y or control groups. During an 8-12 month period, the GSD-Y group will complete 8 outpatient GSD-Y visits, and the control group will completes an equal number of standard visits. The primary outcome is HbA1c. Secondary outcomes include the following: number of self-monitored blood glucose values and levels of autonomous motivation, involvement and autonomy support from parents, autonomy support from HCPs, perceived competence in managing diabetes, well-being, and diabetes-related problems. Primary and secondary outcomes will be evaluated within and between groups by comparing data from baseline, after completion of the visits, and again after a 6-month follow-up. To illustrate how GSD-Y influences glycaemic control and the development of life skills, 10-12 GSD-Y visits will be recorded during the intervention and analysed qualitatively together with individual interviews carried out after follow-up.
  
  
  CONCLUSIONS
  This study will provide evidence of the effectiveness of using a GSD-Y intervention with three parties on HbA1c and life skills and the feasibility of integrating the intervention into routine outpatient clinic visits. Danish Data Association ref nr. 2008-41-2322.
  
  
  BACKGROUND
  ISRCTN54243636.
authors.affiliation: The Research Department & Paediatric Ward, Hillerød Hospital, Denmark. gihu@hih.regionh.dk
authors.forename: Gitte R
authors.initials: GR
authors.lastname: Husted
authors.forename: Birger
authors.initials: B
authors.lastname: Thorsteinsson
authors.forename: Bente Appel
authors.initials: BA
authors.lastname: Esbensen
authors.forename: Eva
authors.initials: E
authors.lastname: Hommel
authors.forename: Vibeke
authors.initials: V
authors.lastname: Zoffmann
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D015190:Blood Glucose Self-Monitoring; D003718:Denmark; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology / Q000628:therapy*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D009042:Motivation; D010044:Outpatient Clinics, Hospital; D010290:Parents; D026684:Personal Autonomy; D012648:Self Care; D020377:Self Efficacy; D012944:Social Support
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human