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Diabetes Care Publish Ahead of Print published online ahead of print May 28, 2008
DOI: 10.2337/dc08-0394
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Original Research

Monitoring and Discussing Health Related Quality of Life in adolescents with type 1 diabetes improves psychosocial well-being. A randomized controlled trial

Maartje de Wit, MSC1,,2, Henriette A. Delemarre-van de Waal, MD, PHD3,,4, Jan Alle Bokma, MD5, Krijn Haasnoot, MD6, Mieke C. Houdijk, MD, PHD7, Reinoud J. Gemke, MD, PHD3 and Frank J. Snoek, PHD1,,2

1Department of Medical Psychology, VU University Medical Center Amsterdam, The Netherlands
2EMGO Institute, VU University Medical Center Amsterdam, The Netherlands
3Department of Pediatrics, VU University Medical Center Amsterdam, The Netherlands
4Institute of Clinical and Experimental Neurosciences, VU University Medical Center Amsterdam, The Netherlands
5Department of Pediatrics, Spaarne Ziekenhuis Hoofddorp, The Netherlands
6Department of Pediatrics, Medical Center Alkmaar, The Netherlands
7Department of Pediatrics, Juliana Kinderziekenhuis Den Haag, The Netherlands

m.dewit{at}vumc.nl

ABSTRACT

Objective: To test the effects of monitoring and discussion of health related quality of life (HRQoL) in adolescents with type 1 diabetes in a multi-center randomized controlled trial.

Research design and Methods: Four centers were randomly assigned to the HRQoL intervention (46 adolescents) or control (45 adolescents) group, with 3 regular visits scheduled within 12 months in both groups. In the HRQoL intervention group, HRQoL of adolescents was assessed using the PedsQL and outcomes were discussed face-to-face during the consultation. The control group received care as usual. Mean differences between the groups at 12 months in physical and psychosocial well-being (CHQ-CF87/PF50, DFCS, CES-D), satisfaction with care (PEQ-D) and HbA1c were determined, controlling for baseline scores.

Results: Mean scores on CHQ subscales Psychosocial health (p < 0.001), Behavior (p < 0.001), Mental health (p < 0.001) and Family activities (p < 0.001) improved in the HRQoL intervention group, except for adolescents with highest HbA1c's. Adolescents in the HRQoL intervention group reported higher Self-esteem (CHQ) at follow-up (p = 0.016) regardless of HbA1c, and were more satisfied with care (p = 0.009) than controls. No significant differences between the two groups over time were observed in HbA1c levels.

Conclusion: Periodic monitoring and discussion of HRQoL in adolescents with diabetes is appreciated and has positive effects on their psychosocial well-being, except for those in poorest control.


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