Web Programs Help Adolescents Control Diabetes

Puberty typically wreaks havoc with diabetes control, but a Yale study that combines adolescence and diabetes coping programs reverses that trend.
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When children with type 1 diabetes enter puberty, the double stress of coping with their condition and the transition to adolescence often leads to reduced control of their diabetes. In a Yale University study, children in this age group (11-14 years old) who used Web-based interactive programs that taught them how to deal with these factors showed improvement in their HbA1c results and quality of life (QOL) scores.

The study in Diabetes Care, "Internet Psycho-Education Programs Improve Outcomes for Youth With Type 1 Diabetes," included 320 children who were randomized to one of two Internet-based interventions, both developed at Yale. TeenCope was designed to help young people with diabetes cope with adolescence, and Managing Diabetes showed them how to better manage the condition, partly through lifestyle modification.

At 12 months, the subjects in both groups had stable quality of life scores and "minimal" increases in HbA1c levels, and there were not significant differences between the two groups in those primary outcomes. After 18 months, however, the young people who had completed both programs had lower HbA1c levels and higher QOL ratings. They also scored higher in social acceptance and self-efficacy, and had lower perceived stress and diabetes-related family conflict, compared with those who had completed just one course.

Margaret Grey, lead author of the study and dean of the Yale School of Nursing, told InformationWeek Healthcare that even though HbA1c results were slightly worse for the children who had taken only one of these programs, those levels were actually better than would have normally been expected in this age group.

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"Some studies show that HbA1c goes up two points, on average, over a year or two [around puberty] and tends to stay up until they're 15 or 16," said Grey, who is also a professor of nursing at Yale. "So being able to maintain control [of their diabetes] over that period is very important."

Why did the kids who took both programs do better than those who did only one? Grey believes that it's because they need both training in coping with adolescence and a "booster" course in how to manage their diabetes. "So the two programs complement each other, and it appears you get better outcomes by doing both."

The study "oversampled" minority kids to present a balanced appraisal of children from different segments of society, Grey noted. "But the Latino and black kids who stayed in the study were more likely to come from a middle-class background vs. a lower-class background," she said. So the results didn't fully account for the many low-income children who don't have high-speed Internet access at home.

The programs used in the study were designed for desktop and laptop computers. The researchers plan to develop versions of these applications that are optimized for mobile devices so they can study the impact on young people. A quarter of U.S. teenagers now access the Web primarily on smartphones or cellphones, according to the Pew Internet Research Center.

Quality of life scores were a primary endpoint of the study, she noted, because she takes a holistic view of health that includes the difficulty of complying with the requirements of diabetes self-management. "If we have treatments that are so burdensome for kids that they commit suicide, they're just as dead as the kids who ultimately end up with serious complications [from diabetes]. So in all of our studies, we've used quality of life as well as HbA1c."