Stabilization of glycemic control and improved quality of life using a shared medical appointment model in adolescents with type 1 diabetes in suboptimal control: Shared appointments in T1D youth
Open accessAbstract
BACKGROUND: Declining glycemic control in type 1 diabetes (T1D) during adolescence persists despite treatment advances. Non-adherence, peer relations, diabetes burnout, risk taking, transition to autonomy, family conflict, and poor quality of life (QOL) are recognized barriers. Shared medical appointments (SMAs) in adolescent T1D may offer benefits, but data are limited. Our objective was to determine whether SMAs, with multi-component interventions utilizing multidisciplinary teams, improve glycemic control and psychosocial outcomes in poorly controlled adolescent T1D. METHODS: SMAs focused on self-management, communication skills, goal setting, glucose pattern recognition, and peer/diabetes team support. SMAs included: individual history and physical, labs, surveys, multidisciplinary educational ice breakers, group session, and individual wrap up. Outcomes were QOL, adherence, and retrospective and prospective glycemic control. Three to six subjects and families came to 3 SMAs and 1 individual appointment every 3 months over 9 months. SUBJECTS: A total of 37 English speaking subjects, ages 12-16 yrs, with T1D ≥ 1 year, and hemoglobin A1c (HbA1c) 7.5-11% enrolled. Thirty-two subjects attended 75% of visits, meeting inclusion criteria. RESULTS: HbA1c worsened in the 9 months before study (ΔHbA1c= 0.7 ± 1.2; p < 0.01), but remained stable during study (ΔHbA1c = 0.01 ± 1.2; p > 0.05). There were significant improvements in overall QOL (p = 0.005), school function (p = 0.006), psychosocial function (p = 0.008), barriers (p = 0.02), adherence (p = 0.01), and communication (p = 0.02). Improvements in school function and communication reached clinical significance. CONCLUSION: SMAs are feasible replacements to individual appointments in adolescent T1D, stabilizing glycemic control and improving QOL. Randomized controlled trials with optimizations are needed to further explore and refine this intervention.
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In-school nutrition and lifestyle programs may work better when family and community are involved.
“Such interventions may be more effective when combined with family and community involvement.1525,1532,1533”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1525]
The Abstract (page unavailable) says multicomponent diabetes interventions addressing family relationships and social support achieved greater improvements in glycemic control. The Study design describes families participating in shared medical appointments, but the paper does not assess in-school nutrition or lifestyle programs or the added effect of community involvement. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn-school nutrition and lifestyle education programs have produced inconsistent results.
“results from in-school nutrition and lifestyle education programs have been inconsistent.1525–1531”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1525]
The Discussion (page unavailable) describes differing outcomes across shared medical appointment studies, and the Abstract (page unavailable) discusses diabetes education for adolescents. Neither addresses results from in-school nutrition and lifestyle education programs. Searches for that phrase and for school-based nutrition and lifestyle interventions found no relevant passage in our copy. (LLM, conf=0.78)
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Cited by
Sorted by citations
Blonde, L., Umpierrez, G. E., Reddy, S. S., McGill, J. B., Berga, S. L., Bush, M., Chandrasekaran, S., DeFronzo, R. A., Einhorn, D., Galindo, R. J., et al. (2022) · Endocrine Practice · doi:10.1016/j.eprac.2022.08.002 · Cited by 507 · see citing works
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- Authors
- Floyd, B. D., Block, J. M., Buckingham, B. B., Ly, T., Foster, N., Wright, R., Mueller, C. L., Hood, K. K., & Shah, A. C.
- Affiliations
- Stanford Medicine (US)
- Department of Pediatric Endocrinology and Metabolism; Stanford University School of Medicine; Stanford CA USA
- Jaeb Center for Health Research (US)
- University of California, Riverside (US)
- Department of Pediatric Surgery; Stanford University School of Medicine; Stanford CA USA
- Corresponding author
- Shah, Avni C
- Venue
- Pediatric Diabetes
- Publisher
- Hindawi Limited
- Published
- 2016-02-26
- Volume
- 18
- Issue
- 3
- Pages
- 204-212
- ISSN
- 1399-543X (ISSN-L)
- OpenAlex
- W2274498057
- Cited by
- 35
- References
- 39
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 5 · 2023: 2 · 2022: 3 · 2021: 6 · 2020: 4 · 2019: 4 · 2018: 2 · 2017: 2 · 2016: 3
- FWCI
- 3.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Pediatric Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Lucile Packard Foundation for Children's Health
- Stanford NIH-NCATS-CTSA (UL1 TR001085)
- Child Health Research Institute of Stanford University
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- type 1 diabetes, adolescents, shared medical appointments, glycemic control, HbA1c, quality of life, medication adherence, self-management, multidisciplinary care, psychosocial outcomes, school function, communication skills, peer support
- MeSH terms
- Self-Management, Treatment Adherence and Compliance, Adolescent, California, Combined Modality Therapy, Diabetes Mellitus, Type 1, Diet, Diabetic, Drug Resistance, Feasibility Studies, Female, Glycated Hemoglobin, Humans, Hyperglycemia, Hypoglycemia, Hypoglycemic Agents, Insulin, Male, Patient Care Team, Patient Education as Topic, Peer Group, Pilot Projects, Quality of Life, Cohort Studies
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