Impact of Family-Centered Tailoring of Pediatric T1D Self-Management Resources

Background: Experts recommend family-centered self-management approaches that address specific T1D self-management barriers for each child and family. However, no system-level method currently exists to identify and address these barriers.

Objectives: To assess the impact on glycemic control and QoL for the child and parent of a family-centered approach to the delivery of diabetes self-management resources.

Methods: Children 8-16 years old with T1D and their parent(s) were randomized to receive either tailored self-management resources (intervention) or usual care. Our intervention 1) identified families’ self-management barriers with a validated survey, 2) tailored self-management resources to identified barriers, and 3) delivered these resources as group sessions coordinated with diabetes visits to optimize convenience, efficiency, and sustainability. Mixed effects models with repeated measures were used to examine the intervention’s impact on A1c and parent and child QoL during the 9-month intervention period and for a year thereafter.

Results: Among 363 potentially eligible families, 267 (74%) consented to participate. Randomization allocated 1families to usual care and 1to the intervention. Participants were children (8-12 years, 44%) and teens (13-16 years, 56%). Mean diabetes duration was 5.4 years (sd 3.3) and 14% had an A1c <7.5%. Most families (69%) attended at least 3 of the 4 intervention sessions. No overall intervention effect on A1c or QoL for the child or parent was shown. However, at one site, mean A1c in the year post-intervention declined by 0.059% more per month for intervention group teens than for those receiving usual care (p=0.02). At this same site, mean parent QoL increased by 0.61 points per month more during the intervention for parents of intervention group children than parents of those receiving usual care (p=0.03).

Conclusions: Findings can inform healthcare organizations’ decisions about ways to best deliver diabetes self-management resources.