Effects of educational and psychosocial interventions for adolescents with diabetes mellitus: a systematic review.

摘要: Background: insulin-dependent diabetes mellitus, also known as type 1 diabetes, is a life-threatening condition and the third most common chronic illness among young people. As result of minimal or non-existent insulin production, people with must take over normally automatic task regulation blood glucose levels. This achieved by complex regimen involving multiple, daily administrations coordinated dietary intake energy expenditure monitored testing. Objectives: to examine effectiveness educational psychosocial interventions for adolescents designed improve their management. Specifically, it addressed following research questions: (1) Do have beneficial effects on biological outcomes? (2) Are there types features that been shown be more effective than others? (3) What evidence cost-effectiveness interventions? Methods: search strategy was formulated, piloted refined. Three journals were handsearched, 11 electronic databases searched personal contacts, flyers, conferences websites used notify community review access further literature. process generated 10,535 abstracts, which, after screening, resulted in 367 articles identified retrieval. number augmented hand-searching, contact exploding references, final total 457 scrutinised. Of these, 64 reports describing 62 studies empirical papers evaluating interventions. The relevant data extracted from summary tables each study prepared. Where possible, effect sizes computed outcomes included randomised control group (CG) other information. Results: descriptive analysis undertaken. Most (67.7%) conducted USA 41% controlled trials (RCTs), none which UK-based. Only 48% provided an explicit theoretical rationale intervention. mean participants 53.8. took place various settings, evaluated variety interventions, involved interventionists, components assessed range outcomes, including measures metabolic psychological behavioural outcomes. Follow-up assessments relatively rare. Results - THE EFFECTIVENESS OF INTERVENTIONS: 25 RCTs examined detail three described depth. Effect could calculated 14 studies. (pooled) size 0.37 0.33 glycated haemoglobin outliers (0.08 without outliers), indicating these small medium management A narrative 21 pre-post no CG performed, evaluations at summer camps, poorly patients All reported effects. COST-EFFECTIVENESS: Few economic considerations associated lack information costs diversity investigators impeded cost- comparisons. Shorter hospitalisation diagnosis least achieving avoiding complications adolescence longer stays. Home care may improved but not cheaper hospital diagnosis. Targeting subjects reduce adverse events hospitalisations cost-effective generic There need rigorous include longer-term considerations. Conclusions: conclusions drawn this review: Educational Well-designed such are needed UK (no completed found). evidence, arising primarily USA, provides starting point design UK. (4) Quantitative suggested likely if they demonstrate inter-relatedness aspects