Stabilization of glycemic control and improved quality of life using a shared medical appointment model in adolescents with type 1 diabetes in suboptimal control

摘要

Background Declining glycemic control in type 1 diabetes ( T1D ) during adolescence persists despite treatment advances. Non‐adherence, peer relations, diabetes burnout, risk taking, transition to autonomy, family conflict, and poor quality of life ( QOL ) are recognized barriers. Shared medical appointments ( SMAs ) in adolescent T1D may offer benefits, but data are limited. Our objective was to determine whether SMAs , with multi‐component interventions utilizing multidisciplinary teams, improve glycemic control and psychosocial outcomes in poorly controlled adolescent T1D . Methods SMAs focused on self‐management, communication skills, goal setting, glucose pattern recognition, and peer/diabetes team support. SMAs included: individual history and physical, labs, surveys, multidisciplinary educational ice breakers, group session, and individual wrap up. Outcomes were QOL , adherence, and retrospective and prospective glycemic control. Three to six subjects and families came to 3 SMAs and 1 individual appointment every 3 months over 9 months. Subjects A total of 37 English speaking subjects, ages 12–16?yrs, with T1D ≥ 1 year, and hemoglobin A1c ( HbA1c ) 7.5‐11% enrolled. Thirty‐two subjects attended 75% of visits, meeting inclusion criteria. Results HbA1c worsened in the 9 months before study (Δ HbA1c = 0.7?±?1.2; p??0.01), but remained stable during study (Δ HbA1c ?=?0.01?±?1.2; p??0.05). There were significant improvements in overall QOL (p?=?0.005), school function (p?=?0.006), psychosocial function (p?=?0.008), barriers (p?=?0.02), adherence (p?=?0.01), and communication (p?=?0.02). Improvements in school function and communication reached clinical significance. Conclusion SMAs are feasible replacements to individual appointments in adolescent T1D , stabilizing glycemic control and improving QOL . Randomized controlled trials with optimizations are needed to further explore and refine this intervention.