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Diabetic medicine : a journal of the British Diabetic Association v.34 no.3, 2017년, pp.340 - 347   SCI SCIE
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Reduction of hypoglycaemic events with a behavioural intervention: a randomized clinical trial for paediatric patients with Type 1 diabetes mellitus

Gee, B. T. (<i>Eunice Kennedy Shriver</i>National Institute of Child Health and Human Development, Bethesda, MD, USA ) ; Nansel, T. R. (<i>Eunice Kennedy Shriver</i>National Institute of Child Health and Human Development, Bethesda, MD, USA ) ; Liu, A. (<i>Eunice Kennedy Shriver</i>National Institute of Child Health and Human Development, Bethesda, MD, USA ) ;
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    Abstract Aims To determine if a low‐intensity, clinic‐integrated behavioural intervention reduced the incidence of hypoglycaemic events in children with Type 1 diabetes. Methods A total of 390 families with children with Type 1 diabetes were enrolled in a 2‐year, randomized clinical trial of a behavioural intervention. The intervention was designed to improve diabetes management practices by targeting the family's diabetes problem‐solving skills. Hypoglycaemic events were categorized in two groups: those treated by oral ingestion and those treated by parenteral therapy. Events were self‐reported by participants at each clinic visit, which occurred approximately every 3–4 months. Analyses included two‐sample t ‐tests, the mean cumulative function test, and the Cox proportional hazards model for recurrent events to compare the incidence between groups. Results Across the entire 2‐year study period, the incidence of hypoglycaemic events treated by oral ingestion of glucose‐rich foods and events requiring parenteral therapy did not significantly differ between study conditions; however, during the second year of participant enrolment, the incidence of events treated by oral ingestion in the intervention group was 13.6 per 100 person‐years compared with 27.3 per 100 patient‐years in the control group ( P = 0.02). The hazard ratio of these events during the second year was 0.49 (95% CI 0.27–0.90; P = 0.02). Conclusions Our findings suggest the need for a long‐term (> 1 year) focus on the implementation of interventions targeting diabetes management in young people. Behavioural interventions targeting problem‐solving skills could be considered as practical, non‐pharmacological strategies to reduce hypoglycaemia in adolescents with Type 1 diabetes.


    What's new? Hypoglycaemia is a common and serious acute complication associated with Type 1 diabetes mellitus. There has been limited research examining whether interventions targeting management can reduce the incidence of hypoglycaemia in young people with Type 1 diabetes.The findings from the present study show that a behavioural intervention targeting problem‐solving skills reduced the risk of hypoglycaemic events treated by oral ingestion during the second year of enrolment.Given the simultaneous improvement in hypoglycaemic risk and glycaemic control (a previous finding), behavioural interventions could be considered as strategies to improve diabetes management in young with Type 1 diabetes.


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