Monitoring and Discussing Health-Related Quality of Life in Adolescents With Type 1 Diabetes Improve Psychosocial Well-Being

A randomized controlled trial

  1. Maartje de Wit, MSC1,2,
  2. Henriette A. Delemarre-van de Waal, MD, PHD3,4,
  3. Jan Alle Bokma, MD5,
  4. Krijn Haasnoot, MD6,
  5. Mieke C. Houdijk, MD, PHD7,
  6. Reinoud J. Gemke, MD, PHD3 and
  7. Frank J. Snoek, PHD1,2
  1. 1Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands
  2. 2EMGO Institute, VU University Medical Center, Amsterdam, the Netherlands
  3. 3Department of Pediatrics, VU University Medical Center, Amsterdam, the Netherlands
  4. 4Institute of Clinical and Experimental Neurosciences, VU University Medical Center, Amsterdam, the Netherlands
  5. 5Department of Pediatrics, Spaarne Ziekenhuis, Hoofddorp, the Netherlands
  6. 6Department of Pediatrics, Medical Center, Alkmaar, the Netherlands
  7. 7Department of Pediatrics, Juliana Kinderziekenhuis, Den Haag, the Netherlands
  1. Corresponding author: Maartje de Wit, m.dewit{at}vumc.nl

Abstract

OBJECTIVE—To test the effects of monitoring and discussing of health-related quality of life (HRQoL) in adolescents with type 1 diabetes in a multicenter randomized controlled trial.

RESEARCH DESIGN AND METHODS—Four centers were randomly assigned to the HRQoL intervention (46 adolescents) or control (45 adolescents) group, with three regular visits scheduled within 12 months in both groups. In the HRQoL intervention group, HRQoL of adolescents was assessed using the Pediatric Quality of Life Inventory, 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 (Child Health Questionnaire [CHQ]-CF87/PF50, Diabetes-Specific Family Conflict Scale, and Center for Epidemiological Studies Scale for Depression), satisfaction with care (Patients’ Evaluation of the Quality of Diabetes Care), and A1C were determined, controlling for baseline scores.

RESULTS—Mean scores on the CHQ subscales of 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 the highest A1C values. Adolescents in the HRQoL intervention group reported higher self-esteem (CHQ) at follow-up (P = 0.016), regardless of A1C, and were more satisfied with care (P = 0.009) than control subjects. No significant differences between the two groups over time were observed in A1C levels.

CONCLUSIONS—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.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 28 May 2008.

    Clinical trial reg. no. ISRCTN65138334, www.ISRCTN.org.

    Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Received February 25, 2008.
    • Accepted May 14, 2008.
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  1. Published online before print May 28, 2008, doi: 10.2337/dc08-0394 Diabetes Care August 2008 vol. 31 no. 8 1521-1526
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