title: Randomized trial of a diabetes self-management education and family teamwork intervention in adolescents with Type 1 diabetes.
abstract: OBJECTIVE
  To evaluate the effectiveness of a family-centred group education programme, in adolescents with Type 1 diabetes.
  
  
  METHODS
  Three hundred and five adolescents with Type 1 diabetes; age 13.1 ± 1.9 years, diabetes duration 5.6 ± 3.3 years, BMI 20.9 ± 3.7 kg/m(2) , HbA(1c) 78 ± 6 mmol/mol (9.3 ± 1.9%) were randomly allocated to the Families and Adolescents Communication and Teamwork Study (FACTS) diabetes education programme; (six 90-min monthly sessions attended by parents and adolescents incorporating skills training and family teamwork) or conventional clinical care. Primary outcome was HbA(1c) at 18 months (12 months post-intervention). Secondary outcomes were HbA(1c) at 9 months, psychosocial outcomes, adolescent quality of life, well-being, family responsibility and insulin dose adjustment behaviours at 12 months (6 months post-intervention) and episodes of severe hypoglycaemia and diabetic ketoacidois during the 12 months post-intervention. All analyses are intention to treat.
  
  
  RESULTS
  Session attendance was poor with 48/158 families (30.4%) not attending any sessions and only 75/158 (47.5%) families attending ≥ 4 group education sessions. All biomedical and psychosocial outcomes were comparable between groups. At 18 months there was no significant difference in HbA(1c) in either group and no between-group differences over time: intervention group 75 mmol/mol (9.0%) to 78 mmol/mol (9.3%), control group 77 mmol/mol (9.2%) to 80 mmol/mol (9.5%). Adolescents perceived no changes in parental input at 12 months.
  
  
  CONCLUSIONS
  Poor attendance of group education sessions delivered in routine clinics was a major challenge. More personalized educational approaches may be required to support and motivate families who are struggling to integrate the demands of intensive insulin regimens into their daily lives.
authors.affiliation: University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Cambridge, UK. hm386@medschl.cam.ac.uk
authors.forename: H R
authors.initials: HR
authors.lastname: Murphy
authors.forename: C
authors.initials: C
authors.lastname: Wadham
authors.forename: J
authors.initials: J
authors.lastname: Hassler-Hurst
authors.forename: G
authors.initials: G
authors.lastname: Rayman
authors.forename: T C
authors.initials: TC
authors.lastname: Skinner
mesh_terms: D000293:Adolescent; D003142:Communication; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D005190:Family; D006126:Group Processes; D006266:Health Education / Q000379:methods*; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration; D012648:Self Care / Q000379:methods*; D012941:Social Responsibility; D016896:Treatment Outcome