Therapeutic Education Improves Lives for Kids with Diabetes

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Over a three-month follow-up period, children and adolescents with type 1 diabetes enrolled in the Therapeutic Patient Education (TPE) program had significant improvements in blood glucose control and quality of life, while the control group showed worsening blood glucose levels.

Although no significant changes in hemoglobin A1C (HbA1C)—a blood test that measures the average blood sugar level over a period of months—were observed among either group, the education program demonstrated better overall outcomes regarding quality of life and glycemic control.

Structured TPE is an essential part of helping patients and their families effectively manage type 1 diabetes, a condition that affects over 1.2 million children and adolescents aged 0 – 19 years worldwide.

“Good management of type 1 diabetes requires, since diagnosis, TPE of the child and his family by a team of specialists as an essential part of the care process,” wrote a group of Moroccan investigators. “TPE, for a long time confused with simple information and instructions formulated during hospitalization or medical consultations, is an educational approach whose beneficial effects on salient outcome measures (e.g., glycemic control; less behavioral, emotional, and social problems; fewer hospital admissions for related complications; and better QoL and wellbeing) have been reported in many studies.”

TPE focuses on skills related to diabetes self-care in addition to psychological patient components in a structured and targeted way.

The non-randomized controlled study evaluated the TPE program effects among a group of 200 children and adolescents, aged 8 to 18 years, with type 1 diabetes between January and December 2022. Patients, recruited from two pediatric departments, were assigned to either the TPE intervention program (100 subjects) or control group (100 subjects). Measurements were collected at baseline and follow-up to assess the differences between the two groups in terms of measured HbA1c and health-related quality of life, which was determined by a validated questionnaire.

The TPE consisted of three weekly, 90-minute group sessions with a pediatric dietician nurse and a nurse educator trained in TPE. The program was used to encourage learning among patients and taught them how to perform self-monitoring measures and insulin therapy. It also helped children to identify and treat short-term complications—such as diabetic ketoacidosis and hypoglycemia—as well as prevent or identify long-term complications. Later in the program, kids learned how to develop diet skills and a positive attitude towards their condition as well as its emotional troubles and other concerns.

“The educational intervention was inspired by a theory often used in pediatric diabetes: Bandura’s social cognitive theory,” investigators explained. “This theory is based on the concept of the self-efficacy feeling, whose sources are active experience, vicarious experience based on the observation of various models such as peers, verbal persuasion and positive behaviors and emotional states leading to the successful execution of the desired behavior. With this self-efficacy feeling, individuals believe in their own abilities to adopt the right behaviors and achieve particular performances.”

At the three-month mark, kids in the TPE intervention group saw significant improvements in the maximum pre- and postprandial blood glucose levels. Additionally, there was a significant increase in the maximum and minimum of the pre-prandial blood glucose levels among controls.

Quality of life was also improved among patients receiving patient education; however, decreases in quality of life were observed in the control group. Patients in the TPE group had fewer diabetes-related symptoms, fewer barriers to treatment or compliance issues, fewer diabetes-related communication problems and fewer illness-related worries.

“Structured TPE has the potential to help type 1 diabetes children and adolescents acquire skills, allowing them to better manage and live with their disease,” investigators wrote. “Nonetheless, for better achievements and to sustain these gains, TPE interventions must be incorporated into routine care in a regular and coordinated way.”

Over a three-month follow-up period, children and adolescents with type 1 diabetes enrolled in the Therapeutic Patient Education (TPE) program had significant improvements in blood glucose control and quality of life, while the control group showed worsening blood glucose levels.

Although no significant changes in hemoglobin A1C (HbA1C)—a blood test that measures the average blood sugar level over a period of months—were observed among either group, the education program demonstrated better overall outcomes regarding quality of life and glycemic control.

Structured TPE is an essential part of helping patients and their families effectively manage type 1 diabetes, a condition that affects over 1.2 million children and adolescents aged 0 – 19 years worldwide.

“Good management of type 1 diabetes requires, since diagnosis, TPE of the child and his family by a team of specialists as an essential part of the care process,” wrote a group of Moroccan investigators. “TPE, for a long time confused with simple information and instructions formulated during hospitalization or medical consultations, is an educational approach whose beneficial effects on salient outcome measures (e.g., glycemic control; less behavioral, emotional, and social problems; fewer hospital admissions for related complications; and better QoL and wellbeing) have been reported in many studies.”

TPE focuses on skills related to diabetes self-care in addition to psychological patient components in a structured and targeted way.

The non-randomized controlled study evaluated the TPE program effects among a group of 200 children and adolescents, aged 8 to 18 years, with type 1 diabetes between January and December 2022. Patients, recruited from two pediatric departments, were assigned to either the TPE intervention program (100 subjects) or control group (100 subjects). Measurements were collected at baseline and follow-up to assess the differences between the two groups in terms of measured HbA1c and health-related quality of life, which was determined by a validated questionnaire.

The TPE consisted of three weekly, 90-minute group sessions with a pediatric dietician nurse and a nurse educator trained in TPE. The program was used to encourage learning among patients and taught them how to perform self-monitoring measures and insulin therapy. It also helped children to identify and treat short-term complications—such as diabetic ketoacidosis and hypoglycemia—as well as prevent or identify long-term complications. Later in the program, kids learned how to develop diet skills and a positive attitude towards their condition as well as its emotional troubles and other concerns.

“The educational intervention was inspired by a theory often used in pediatric diabetes: Bandura’s social cognitive theory,” investigators explained. “This theory is based on the concept of the self-efficacy feeling, whose sources are active experience, vicarious experience based on the observation of various models such as peers, verbal persuasion and positive behaviors and emotional states leading to the successful execution of the desired behavior. With this self-efficacy feeling, individuals believe in their own abilities to adopt the right behaviors and achieve particular performances.”

At the three-month mark, kids in the TPE intervention group saw significant improvements in the maximum pre- and postprandial blood glucose levels. Additionally, there was a significant increase in the maximum and minimum of the pre-prandial blood glucose levels among controls.

Quality of life was also improved among patients receiving patient education; however, decreases in quality of life were observed in the control group. Patients in the TPE group had fewer diabetes-related symptoms, fewer barriers to treatment or compliance issues, fewer diabetes-related communication problems and fewer illness-related worries.

“Structured TPE has the potential to help type 1 diabetes children and adolescents acquire skills, allowing them to better manage and live with their disease,” investigators wrote. “Nonetheless, for better achievements and to sustain these gains, TPE interventions must be incorporated into routine care in a regular and coordinated way.”