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

doi:10.2337/dc08-0394

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, MSC (m.dewit{at}vumc.nl)^1,,²,
Henriette A. Delemarre-van de Waal, MD, PHD^3,,⁴,
Jan Alle Bokma, MD⁵,
Krijn Haasnoot, MD⁶,
Mieke C. Houdijk, MD, PHD⁷,
Reinoud J. Gemke, MD, PHD³ and
Frank J. Snoek, PHD^1,,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

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 HbA_1c 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 HbA_1c's. Adolescents in the HRQoL intervention group reported higher Self-esteem (CHQ) at follow-up (p = 0.016) regardless of HbA_1c, and were more satisfied with care (p = 0.009) than controls. No significant differences between the two groups over time were observed in HbA_1c 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.