Background: Dietary education aims to facilitate diabetes self-management skills to achieve optimal glycaemic control. Poor glycaemic control is associated with micro-vascular (retinopathy, nephropathy and neuropathy) and macro-vascular (cardiovascular) diseases, which risk poor quality of life and reduced life expectancy (The Diabetes Control and Complications Study Group, 1994). The aim of this project was to conduct a literature review of factors that influence adolescent diabetes educational needs.
Methods: A literature review was conducted using the method of Aveyard (2007) by searching Medline, Cinahl, EMBASE, Cochrane and ISIS Web of Knowledge databases. Electronic searches were conducted on single terms and as Boolean searches using the patient group (adolescen*, child*, teenager, pediatric, paediatric), disease focus (type 1 diabetes, multiple daily injections, basal bolus) and intervention (education needs, diabetes education, diabetes care, self management). Hand searching of key journals was also conducted. The inclusion criteria were studied that reported directly on children or adolescents (<20 years) type 1 diabetes and in the English only. The selected publications were critically appraised using Critical Appraisal Skills Programme tools to assess methodological quality and determine significance of the reported findings (Public Health Resource Unit, England, 2007).
Results: Limited quality literature is available to conclude what adolescent views are in relation to dietary educational needs. In total 36 articles were identified and abstracts screened. A total of eight were identified as relevant. Literature to determine nutritional factors to assist adolescent diabetes self management and carbohydrate counting is also weak and mainly consensus based, however carbohydrate counting is acknowledged as a useful tool. In total 67 articles were identified and abstracts screened. A total of six were identified as relevant.
Discussion: The review by Couch et al. (2008) highlighted that there is insufficient evidence to identify a particular diabetes intervention that is more effective than standard care. Factors indicated by adolescents that may assist receptiveness to diabetes education and management discussed: continued support from parents; research participation; application and practice of decision making; insulin adjustment to achieve positive outcome; and the importance of education to dispel inappropriate dietary restrictions. Nutritional factors worth considering with regard to dietary management highlighted: healthy eating reinforcement; carbohydrate counting and dietary education tools to promote self management skills; accuracy of dietary education; and methods of engagement which support structured patient education for adolescents.
Conclusion: Limited published evidence is available on factors that influence the educational needs of adolescents with type 1 diabetes. A trial of group education to target problem solving strategies is a proposed recommendation for service development.
References: Aveyard, H. (2007) Doing a Literature Review in health and social care. A practical guide. pp. 57–123. Buckingham: Open University Press.
Couch, R., Jetha, M., Drydren, D. M., Hooten, N., Liang, Y., Durec, T., Sumamo, E., Spooner, C., Milne, A., O’Gorman, K. & Klassen, T.P. (2008) Diabetes education for children with type 1 diabemtes mellitus and their families. Evid. Rep./Technol. Assess. (Full Rep) (166):1–144.
Public Health Resource Unit (PHRU), England (2007) Critical Appraisal Skills Programme Appraisal Tools. http://www.phru.nhs.uk/casp/casp.htm [Accessed on 20 May 2009].
The Diabetes Control and complications Study Group (1994) Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial Research Group. J. Pediatr. 125, 177–188.