Abstract

Objective- To evaluate the impact of a preconception counseling (PC) program tailored for teens with type-1-diabetes on cognitive, psychosocial, and behavioral outcomes and to assess its cost-effectiveness.

Research design and methods- Eighty-eight teens with type-1-diabetes from 2-sites were randomized into the “READY-Girls” (Reproductive-health Education and Awareness of Diabetes in Youth for Girls) intervention (IG) (n=43) or standard care (SC) (n=45) groups. During 3 diabetes clinic visits, IG subjects viewed a two-part CD-ROM, read a book, and met with a nurse. Program effectiveness was measured by knowledge, attitudes, intentions and behaviors regarding diabetes, pregnancy, sexuality, and PC. Assessments occurred at baseline, before and after viewing program materials, and at 9-months. Economic analyses included an assessment of resource utilization, direct medical costs, and a break-even cost analysis.

Results- Age range was 13.2-19.7 years(mean=16.7±s.d 1.7 years); 6 (n=5) were African American and 24%(n=21) were sexually active. Compared to baseline and SC subjects, IG subjects demonstrated a significant group-by-time interaction for benefit and knowledge of PC and reproductive-health: increasing immediately after the first visit (p<0.001) and being sustained for 9-months (p<0.05 benefits; p<0.001 knowledge). For IG subjects, PC barriers decreased over time (p<0.001), and intention and initiation of PC and reproductive-health discussions increased (p<0.001). Costs of adverse reproductive outcomes are high. Direct medical costs of READY-Girls were low.

Conclusion- READY-Girls was beneficial and effects were sustained for at least 9-months. This low-cost self-instructional program can potentially empower young women with type-1-diabetes to make well informed reproductive-health choices, adding little time burden or cost to their diabetes management.