The Best of Coping: A Randomised Trial to Improve Glycaemic Control and Psychosocial Wellbeing in Adolescents with Type 1 Diabetes

Abstract

Type 1 diabetes mellitus (T1DM) is a challenging and complex chronic illness that is associated with serious long-term health complications. T1DM requires intensive self- management in order to regulate blood glucose levels and minimise the risk for biomedical complications. Adolescents with T1DM are considered a vulnerable group, as they are at increased risk for deterioration in glycaemic control (control of blood glucose levels) as well as at increased risk for psychiatric disorders. Psychosocial interventions have tried to reduce these risk factors, and despite moderate improvements it remains unclear which therapeutic approaches and intervention components are the most successful in improving glycaemic control and psychological wellbeing. In order to clarify these issues the following studies were undertaken: (1) a qualitative study was used to modify a generic coping skills program to suit adolescents with T1DM, and (2) a randomised controlled trial (RCT) was conducted to evaluate the modified program and its impact on improving glycaemic control and psychosocial outcomes. The RCT also sought to evaluate the efficacy of cognitive behavioural theory as an underlying framework for interventions for youth with T1DM. Thirteen adolescents with T1DM participated in the qualitative study, and 156 adolescents with T1DM participated in the RCT. The RCT was evaluated at three months after baseline, with per-protocol analyses demonstrating statistically significant improvements in productive coping skills (p=0.022), diabetes-specific self-efficacy (p=0.046), diabetes-related stress (p=0.047), and quality of life (p=0.030) in the treatment group compared to the control group. Although glycaemic control improved in the treatment group compared to the control group (effect size of 0.28), the difference was not statistically significant (p=0.227). The significant improvements seen in psychosocial outcomes testify to the success of the modified coping skills program and the importance of targeting cognitions as part of psychosocial interventions for adolescents with T1DM. If offered as part of standard care, the program is expected to reduce mental health morbidity and improve quality of life in adolescents with T1DM.