Use of Diabetes Technology in Children: Role of Structured Education for Young People with Diabetes and Families.

The current era has witnessed an explosion of advanced diabetes technologies. Young people with diabetes and their families require detailed, structured diabetes education in order to optimize use of such devices. There is need for youth and their families to participate in the selection of particular devices for personal use and comprehensive education regarding the safe and effective use of such technologies. The education process should ensure that youth and their families receive realistic expectations of what the advanced technologies can and cannot do to avoid disappointment and the premature discontinuation of such systems.

Components of Interventions That Improve Transitions to Adult Care for Adolescents With Type 1 Diabetes.

Adolescents with type 1 diabetes struggle with glycemic control with decline further exacerbated by transfer from pediatric to adult care. The purpose of this systematic review/meta-analysis was to examine which components of transition programs are effective in improving outcomes following transfer. We searched six databases for studies that assessed the efficacy of a transition program on diabetes outcomes. Studies reporting hemoglobin A1c (HbA1c) or its change for the intervention versus control group pretransition and posttransition were pooled using a random effects meta-analysis model. Of 4,689 studies identified, 18 (1 randomized control trial, 6 quasi-experimental, 1 prospective, and 10 retrospective cohort) met inclusion criteria. Findings represent data from 3,382 youth with type 1 diabetes (52% male, age 16-23 years) undergoing transition. Programs varied and included transition coordinators (n = 7), transition clinics (n = 10), and group education meetings (n = 5). Average age of transfer was 17.7 years. All but one study reported improvement/maintenance of HbA1c posttransition. However, pooling data from four studies with a control group (418 youth), there were no differences in HbA1c at 12 months (-.11 [95% confidence interval: -.31, .08]). Of other outcomes studied (clinic attendance [n = 12], severe hypoglycemia [n = 8], and diabetic ketoacidosis [n = 7]), transition programs showed greatest consistency in reducing diabetic ketoacidosis episodes. Findings suggest that transition interventions may be effective in maintaining glycemic control and reducing diabetic ketoacidosis episodes posttransition. Further research is needed to determine which program types are most effective.

Text messaging intervention for teens and young adults with diabetes.

Adolescents and young adults use text messaging as their primary mode of communication, thus providing an opportunity to use this mode of communication for mobile health (mHealth) interventions. Youth with diabetes are an important group for these mHealth initiatives, as diabetes management requires an enormous amount of daily effort and this population has difficulty achieving optimal diabetes management. Goal setting and self-efficacy are 2 factors in the management of diabetes. We examined the feasibility of a healthy lifestyle text messaging program targeting self-efficacy and goal setting among adolescents and young adults with diabetes. Participants, ages 16-21, were assigned to either a text messaging group, which received daily motivational messages about nutrition and physical activity, or a control group, which received paper-based information about healthy lifestyle. Both groups set goals for nutrition and physical activity and completed a measure of self-efficacy. Participants' mean age was 18.7 ± 1.6 years old, with diabetes duration of 10.0 ± 4.6 years, and A1c of 8.7 ± 1.7%. The text messaging intervention was rated highly and proved to be acceptable to participants. Self-efficacy, glycemic control, and body mass index did not change over the course of the short, 1-month pilot study. Positive, daily, motivational text messages may be effective in increasing motivation for small goal changes in the areas of nutrition and physical activity. These interventions may be used in the future in youth with diabetes to improve diabetes care. Utilizing more targeted text messages is an area for future research.