Randomized trial of a diabetes self-management education and family teamwork intervention in adolescents with Type 1 diabetes.

AIMS: 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. CONCLUSION: 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.

A double-blind study comparing 0.5% and 1% tropicamide for annual retinal screening in diabetic adolescents.

AIMS: To determine whether there is any difference between 0.5% and 1% tropicamide in ocular discomfort and mydriatic efficacy in adolescents with Type 1 diabetes. METHODS: In a double-blind study, one drop of 0.5% tropicamide was instilled in one eye and one drop of 1% instilled in the other eye of 30 subjects aged 12-18 years. Drop strengths were randomized. Pupil size was measured before instillation, at 10, 20 and 30 min. Discomfort was measured using a recognized pain scale. RESULTS: Irrespective of the concentration of tropicamide used, all pupils dilated to at least 6 mm at 30 min, sufficient for successful ophthalmoscopy. Pain was significantly less when the lower concentration of tropicamide was used; pain score for the 0.5% group [median (interquartile range)] 1.0 (0-2) and 2.0 (1-3) for the 1.0% group, P = 0.009 (Wilcoxon rank test). CONCLUSIONS: This minor change in practice significantly reduces the distress associated with drop instillation without compromising the clinical examination, and may thus be important in encouraging compliance at the yearly diabetic review.