Evaluation of the Effectiveness of a Structured Diabetes Education Programme (CHOICE) on Clinical Outcomes for Adolescents with Type 1 Diabetes: A Randomised Controlled Trial

Abstract

Aim: To evaluate the impact of the CHOICE structured diabetes education programme for adolescents with Type 1 diabetes on glycossylated haemoglobin, body mass index, episodes of hyper and hypoglycaemia and dietary adherence. Methods: Multi-centred pragmatic randomised controlled trial (ISRCTN 13331558) across seven hospital sites in Northern Ireland, with 24 month follow-up. 135 adolescents between 13 – 19 years with Type 1 diabetes were randomly assigned to structured diabetes education (n = 70) or control (n = 65). The intervention was designed to enable adolescents to adjust diet and insulin regimens, liberating their lifestyle to more closely match that of their peers without diabetes. It consisted of 12 hours education over 4 weeks, in 3 hourly interactive, group based sessions. Clinical outcome measures included glycossylated haemoglobin (HbA1c), body mass index, number of episodes of reported hyperglycaemia and hypoglycaemia and dietary adherence. Data were analysed on an intention to treat basis and was undertaken by a series of tests assessing both within and between group differences in means, variances and covariances. Results: No significant difference between groups in HbA1c was noted despite the dietary liberation of the intervention group at 12 months however, there was a significant difference at 24 months (HbA1c) IG intervention % (mmol/mol) 9.53(81) v 8.99(75) control. There was no difference in BMI or in reported hyper or hypoglycaemic episodes. Conclusion: Structured diabetes education (SDE) facilitated a more flexible diet, to which adolescents could adhere, with no detriment to glycaemic control at 12 m, but not at 24 m post intervention.