The effect of the Talking Diabetes consulting skills intervention on glycaemic control and quality of life in children with type 1 diabetes: cluster randomised controlled trial (DEPICTED study)
- PMID: 22539173
- PMCID: PMC3339876
- DOI: 10.1136/bmj.e2359
The effect of the Talking Diabetes consulting skills intervention on glycaemic control and quality of life in children with type 1 diabetes: cluster randomised controlled trial (DEPICTED study)
Abstract
Objective: To evaluate the effectiveness on glycaemic control of a training programme in consultation skills for paediatric diabetes teams.
Design: Pragmatic cluster randomised controlled trial.
Setting: 26 UK secondary and tertiary care paediatric diabetes services.
Participants: 79 healthcare practitioners (13 teams) trained in the intervention (359 young people with type 1 diabetes aged 4-15 years and their main carers) and 13 teams allocated to the control group (334 children and their main carers).
Intervention: Talking Diabetes programme, which promotes shared agenda setting and guiding communication style, through flexible menu of consultation strategies to support patient led behaviour change.
Main outcome measures: The primary outcome was glycated haemoglobin (HbA(1c)) level one year after training. Secondary outcomes were clinical measures (hypoglycaemic episodes, body mass index, insulin regimen), general and diabetes specific quality of life, self reported and proxy reported self care and enablement, perceptions of the diabetes team, self reported and carer reported importance of, and confidence in, undertaking diabetes self management measured over one year. Analysis was by intention to treat. An integrated process evaluation included audio recording a sample of 86 routine consultations to assess skills shortly after training (intervention group) and at one year follow-up (intervention and control group). Two key domains of skill assessment were use of the guiding communication style and shared agenda setting.
Results: 660/693 patients (95.2%) provided blood samples at follow-up. Training diabetes care teams had no effect on HbA(1c) levels (intervention effect 0.01, 95% confidence interval -0.02 to 0.04, P=0.5), even after adjusting for age and sex of the participants. At follow-up, trained staff (n=29) were more capable than controls (n=29) in guiding (difference in means 1.14, P<0.001) and agenda setting (difference in proportions 0.45, 95% confidence interval 0.22 to 0.62). Although skills waned over time for the trained practitioners, the reduction was not significant for either guiding (difference in means -0.33, P=0.128) or use of agenda setting (difference in proportions -0.20, -0.42 to 0.05). 390 patients (56%) and 441 carers (64%) completed follow-up questionnaires. Some aspects of diabetes specific quality of life improved in controls: reduced problems with treatment barriers (mean difference -4.6, 95% confidence interval -8.5 to -0.6, P=0.03) and with treatment adherence (-3.1, -6.3 to -0.01, P=0.05). Short term ability to cope with diabetes increased in patients in intervention clinics (10.4, 0.5 to 20.4, P=0.04). Carers in the intervention arm reported greater excitement about clinic visits (1.9, 1.05 to 3.43, P=0.03) and improved continuity of care (0.2, 0.1 to 0.3, P=0.01).
Conclusions: Improving glycaemic control in children attending specialist diabetes clinics may not be possible through brief, team-wide training in consultation skills.
Trial registration: Current Controlled Trials ISRCTN61568050.
Conflict of interest statement
Competing interests: All authors have completed the ICMJE uniform disclosure form at
Comment in
-
Self management education and good professional consultation skills for patients with diabetes.BMJ. 2012 Apr 26;344:e2673. doi: 10.1136/bmj.e2673. BMJ. 2012. PMID: 22539175 No abstract available.
Similar articles
-
Development and evaluation by a cluster randomised trial of a psychosocial intervention in children and teenagers experiencing diabetes: the DEPICTED study.Health Technol Assess. 2011 Aug;15(29):1-202. doi: 10.3310/hta15290. Health Technol Assess. 2011. PMID: 21851764 Clinical Trial.
-
Structured, intensive education maximising engagement, motivation and long-term change for children and young people with diabetes: a cluster randomised controlled trial with integral process and economic evaluation - the CASCADE study.Health Technol Assess. 2014 Mar;18(20):1-202. doi: 10.3310/hta18200. Health Technol Assess. 2014. PMID: 24690402 Free PMC article. Clinical Trial.
-
Development and Evaluation of a Psychosocial Intervention for Children and Teenagers Experiencing Diabetes (DEPICTED): a protocol for a cluster randomised controlled trial of the effectiveness of a communication skills training programme for healthcare professionals working with young people with type 1 diabetes.BMC Health Serv Res. 2010 Feb 9;10:36. doi: 10.1186/1472-6963-10-36. BMC Health Serv Res. 2010. PMID: 20144218 Free PMC article. Clinical Trial.
-
A facilitated home-based cardiac rehabilitation intervention for people with heart failure and their caregivers: a research programme including the REACH-HF RCT.Southampton (UK): NIHR Journals Library; 2021 Feb. Southampton (UK): NIHR Journals Library; 2021 Feb. PMID: 33617178 Free Books & Documents. Review.
-
A web-based self-management programme for people with type 2 diabetes: the HeLP-Diabetes research programme including RCT.Southampton (UK): NIHR Journals Library; 2018 Sep. Southampton (UK): NIHR Journals Library; 2018 Sep. PMID: 30199193 Free Books & Documents. Review.
Cited by
-
An Online Structured Diabetes Self-Management Education and Support Programme Improves Glycaemic Control in Young Adults with Type 1 Diabetes.J Multidiscip Healthc. 2023 Sep 7;16:2641-2654. doi: 10.2147/JMDH.S414102. eCollection 2023. J Multidiscip Healthc. 2023. PMID: 37701178 Free PMC article.
-
"Less is more": A design thinking approach to the development of the agenda-setting conversation cards for people with type 2 diabetes.PEC Innov. 2022 Nov 10;1:100097. doi: 10.1016/j.pecinn.2022.100097. eCollection 2022 Dec. PEC Innov. 2022. PMID: 37213776 Free PMC article.
-
ISPAD Clinical Practice Consensus Guidelines 2022: Psychological care of children, adolescents and young adults with diabetes.Pediatr Diabetes. 2022 Dec;23(8):1373-1389. doi: 10.1111/pedi.13428. Epub 2022 Dec 5. Pediatr Diabetes. 2022. PMID: 36464988 Free PMC article. No abstract available.
-
ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes in adolescence.Pediatr Diabetes. 2022 Nov;23(7):857-871. doi: 10.1111/pedi.13408. Pediatr Diabetes. 2022. PMID: 36250644 Free PMC article. Review. No abstract available.
-
The effectiveness of psychological interventions on mental health and quality of life in people living with type 1 diabetes: a systematic review and meta-analysis.Diabetol Int. 2022 Jan 28;13(3):513-521. doi: 10.1007/s13340-021-00564-9. eCollection 2022 Jul. Diabetol Int. 2022. PMID: 35693990 Free PMC article.
References
-
- Patterson C, Dahlquist G, Gyürüs E, Green A, Soltész G, EURODIAB Study Group. Incidence trends for childhood type 1 diabetes in Europe during 1989-2003 and predicted new cases 2005-20: a multicentre prospective registration study. Lancet 2009;373:2027-33. - PubMed
-
- Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med 1993;329:977-86. - PubMed
-
- La Greca A, Follansbee D, Skyler J. Developmental and behavioral aspects of diabetes management in youngsters. J Child Health Care 1990;24:239-44.
-
- National Institute for Clinical Excellence. Type 1 diabetes: diagnosis and management of type 1 diabetes in children, young people and adults. NICE, 2004.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous