Psycho-educational interventions for children and young people with Type 1 Diabetes in the UK: How effective are they? A systematic review and meta-analysis

• Published in: PloS one Vol. 12; no. 6; p. e0179685
• Main Authors: Charalampopoulos, Dimitrios, Hesketh, Kathryn R, Amin, Rakesh, Paes, Veena Mazarello, Viner, Russell M, Stephenson, Terence
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 30-06-2017; Public Library of Science (PLoS)
• Subjects: Adolescent; Adolescents; Adult; Analysis; Biology and life sciences; Child; Child development; Children; Children & youth; Childrens health; Clinical trials; Cytochrome P-450; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 1 - psychology; Diabetes Mellitus, Type 1 - therapy; Education; Effectiveness; Evidence-Based Medicine; Female; Glucose; Glycosylated hemoglobin; Health aspects; Hemoglobin; Humans; Indicators; Intervention; Male; Medicine and Health Sciences; Meta-analysis; Metabolism; Patient Education as Topic - methods; Patient Education as Topic - standards; People and Places; Physical Sciences; Prevention; Psychotherapy - methods; Psychotherapy - standards; Quality of life; Randomized Controlled Trials as Topic; Research and Analysis Methods; Search methods; Skill development; Social interactions; Teenagers; Type 1 diabetes; United Kingdom; Young Adult; Young adults
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0179685

To synthesise evidence from UK-based randomised trials of psycho-educational interventions in children and young people (CYP) with Type 1 Diabetes (T1D) to inform the evidence-base for adoption of such interventions into the NHS.
We searched Medline, Embase, Cochrane, PsycINFO, CINAHL, and Web of Science up to March 2016. Two reviewers independently selected UK-based randomised trials comparing psycho-educational interventions for improving management of T1D for CYP with a control group of usual care or attention control. The main outcome was glycaemic control measured by percentage of glycated haemoglobin (HbA1c); secondary outcomes included psychosocial functioning, diabetes knowledge, adverse and other clinical outcomes. A narrative synthesis and meta-analysis were conducted. Pooled effect sizes of standardised mean difference (SMD) were calculated.
Ten eligible trials of three educational and seven psycho-educational interventions were identified. Most interventions were delivered by non-psychologists and targeted adolescents with more than one year duration of diabetes. Meta-analysis of nine of these trials (N = 1,838 participants) showed a non-significant reduction in HbA1c attributable to the intervention (pooled SMD = -0.06, 95% CI: -0.21 to 0.09). Psycho-educational interventions aiming to increase children's self-efficacy had a moderate, beneficial effect (SMD = 0.50, 95% CI: 0.13 to 0.87). No benefits on diabetes knowledge and other indicators of psychosocial functioning were identified.
There is insufficient evidence to recommend the use of particular psycho-educational programme for CYP with T1D in the UK. Further trials with sufficient power and reporting standards are needed. Future trials could consider active involvement of psychological specialists in the delivery of psychologically informed interventions and implementation of psycho-educational interventions earlier in the course of the disease.
PROSPERO CRD42015010701.