group education trial to improve transition in type 1 diabetes

Conditions: Diabetes Mellitus, Type 1; Type1diabetes; Insulin Dependent Diabetes

Summary: the investigators will conduct a randomized controlled trial (rct) to examine group education visits as an innovative and potentially cost-effective approach to transition care delivery, that can be easily integrated into usual diabetes care. among emerging adults with type 1 diabetes (t1d), the investigators aim to assess the effect of group education visits integrated into pediatric care, compared with usual care on hemoglobin a1c (hba1c), adverse outcomes and psychosocial measures after the transfer to adult care. the investigators will conduct a multi-site, parallel group, blinded (outcome assessors, data analysts), superiority randomized controlled trial (rct) of adolescents with t1d (17 years of age) followed at one of the two university teaching hospital-based pediatric diabetes clinics in montreal. interventions will occur over 12-months. follow-up will be to 24 months from enrollment.

rationale. the transition from pediatric to adult diabetes care is a challenging period for adolescents and emerging adults (ages 18-30 years) with type 1 diabetes (t1d). it is characterized by a deterioration in glycemic control (hemoglobin a1c \[hba1c\]), decreased adherence to self-management tasks and to clinic attendance and an increased risk of adverse outcomes. the investigators propose to examine group education visits as a potentially cost-effective approach. in emerging adults with t1d, the investigators hypothesize that group education visits, as compared with usual care, will result in better hba1c, less adverse outcomes and better psychosocial outcomes after the transfer to adult care. primary aim. to determine the impact of group educations visits, compared with usual care, on hba1c after the transfer to adult care. secondary aims. 1. to determine the impact of group education visits, compared with usual care, on time between last pediatric and first adult t1d visit (gap \> 6 months), emergency department (ed) visits and hospitalizations, severe hypoglycemic events, stigma, self-efficacy, disease knowledge, transition readiness, quality of life (qol) and diabetes distress, after the transfer to adult care. 2. to determine the cost-effectiveness of group education visits. methods. the investigators will conduct a multi-site, parallel group, blinded (outcome assessors, data analysts), superiority randomized controlled trial (rct) of adolescents with t1d (17 years of age) followed at one of the two university teaching hospital-based pediatric diabetes clinics in montreal. patients will be recruited over 24 months. interventions will occur over 12-months. follow-up will be to 24 months from enrollment. allocation will be concealed with a 1:1 intervention to control ratio . visits in the active arm will consist of a group education session followed by an individual appointment with the diabetes care physician every 3-months. the group education session, facilitated by a diabetes nurse educator or dietitian, will consist of a patient-driven discussion on topics relevant to adolescents with t1d. patients in the control group, will have in parallel with the intervention group, individual appointments with their diabetes provider as per usual care. the primary outcome is the change in hba1c measured at 24 months (hba1c measured at 24 months - hba1c measured at baseline). secondary outcomes are delays in establishing adult t1d care (y/n), t1d-related hospitalizations and ed-visits (rates/p-y), severe hypoglycemic events, stigma, self-efficacy, diabetes knowledge, transition readiness, diabetes distress, and qol. assessments are at baseline, 12 and 24 months . analysis will be by intention to treat. outcomes will be calculated and compared between the two trial arms using differences with 95% confidence intervals, along with a cost-effectiveness analysis.

Eligibility criteria:
inclusion criteria: * adolescents with a diagnosis of type 1 diabetes * 16 to 17 years of age * receiving diabetes care at one of two university teaching hospital-based pediatric diabetes clinics in montreal: montreal children's hospital (mch) or centre hospitalier universitaire sainte justine (chusj) * fluent in english or french exclusion criteria: * severe neurocognitive disabilities that may preclude patient's ability to participate in a group education visit * patients with conditions associated with shortened erythrocyte survival, such as hemolytic anemia or other conditions associated with inaccurate hba1c

Keywords: transition care pediatric adolescent education hemaglobin a1c health services randomized controlled trial