An ongoing struggle: a mixed-method systematic review of interventions, barriers and facilitators to achieving optimal self-care by children and young people with Type 1 Diabetes in educational settings

BMC Pediatrics

John W Gregory⁴  Llinos Haf Spencer³  Lesley Lowes²  Jane Noyes¹  Deborah Edwards² 

[1]School of Social Sciences, Bangor University, Bangor LL57 2EF, UK

[2]School of Healthcare Sciences College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK

[3]School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK

[4]Department of Child Health, Wales School of Medicine, Cardiff University, Cardiff, UK

关键词: School nurse;    College;    University;    School;    Educational setting;    Young Person;    Adolescent;    Children;    Diabetes Type 1;    Systematic review;   

Others  :  1137291
DOI  :  10.1186/1471-2431-14-228

 received in 2014-01-07, accepted in 2014-08-22,  发布年份 2014

【 摘 要 】

Background

Type 1 diabetes occurs more frequently in younger children who are often pre-school age and enter the education system with diabetes-related support needs that evolve over time. It is important that children are supported to optimally manage their diet, exercise, blood glucose monitoring and insulin regime at school. Young people self-manage at college/university.

Method

Theory-informed mixed-method systematic review to determine intervention effectiveness and synthesise child/parent/professional views of barriers and facilitators to achieving optimal diabetes self-care and management for children and young people age 3–25 years in educational settings.

Results

Eleven intervention and 55 views studies were included. Meta-analysis was not possible. Study foci broadly matched school diabetes guidance. Intervention studies were limited to specific contexts with mostly high risk of bias. Views studies were mostly moderate quality with common transferrable findings.

Health plans, and school nurse support (various types) were effective. Telemedicine in school was effective for individual case management. Most educational interventions to increase knowledge and confidence of children or school staff had significant short-term effects but longer follow-up is required. Children, parents and staff said they struggled with many common structural, organisational, educational and attitudinal school barriers. Aspects of school guidance had not been generally implemented (e.g. individual health plans). Children recognized and appreciated school staff who were trained and confident in supporting diabetes management.

Research with college/university students was lacking. Campus-based college/university student support significantly improved knowledge, attitudes and diabetes self-care. Self-management was easier for students who juggled diabetes-management with student lifestyle, such as adopting strategies to manage alcohol consumption.

Conclusion

This novel mixed-method systematic review is the first to integrate intervention effectiveness with views of children/parents/professionals mapped against school diabetes guidelines. Diabetes management could be generally improved by fully implementing and auditing guideline impact. Evidence is limited by quality and there are gaps in knowledge of what works. Telemedicine between healthcare providers and schools, and school nurse support for children is effective in specific contexts, but not all education systems employ onsite nurses. More innovative and sustainable solutions and robust evaluations are required. Comprehensive lifestyle approaches for college/university students warrant further development and evaluation.

【 授权许可】

   
2014 Edwards et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]DIAMOND Project Group: Incidence and trends of childhood Type 1 diabetes worldwide 1990–1999. Diabet Med 2006, 23:587-566.
• [2]Patterson CC, Dahlquist GG, Gyürüs E, Green A, Soltész G, EURODIAB Study Group: Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–20: A multicentre prospective registration study. Lancet 2009, 373(373):2027-2033.
• [3]O'Neill K, Jonnalagadda S, Hopkins B, Kicklighter J: Quality of life and diabetes knowledge of young persons with type 1 diabetes: influence of treatment modalities and demographics. J Am Diet Assoc 2005, 105(1):85-91.
• [4]Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993, 329:977-986.
• [5]Tolbert R: Managing type 1 diabetes at school: an integrative review. J Sch Nurs 2009, 25:55-61.
• [6]Wodrich D, Hasan K, Parent K: Type 1 diabetes mellitus and school: A review. Pediatr Diabetes 2010, 12:63-70.
• [7]Noyes J, Williams A, Allan D, Brocklehurst P, Carter C, Gregory J, Jackson C, Lewis M, Lowes L, Russell I, Rycroft-Malone J, Sharp J, Samuels M, Tudor Edwards R, Whittaker R: Evidence into practice: evaluating a child-centred intervention for diabetes medicine management: The EPIC Project. BMC Paediatrics 2010, 10:70. BioMed Central Full Text
• [8]Department of Health: Making Every Young Person with Diabetes Matter. Report of the Children and Young People with Diabetes Working Group. London: Department of Health; 2007.
• [9]Welsh Assembly Government: Access to education and support for children and young people with medical needs. Cardiff: Welsh Assembly Government; 2010.
• [10]Department for Education and Skills: Managing Medicines in Schools and Early Years Settings, (updated November 2007). Cheshire: Department of Education; 2005.
• [11]Royal College of Nursing: Supporting children and young people with diabetes. Guidance for nurses in schools and early years settings. London: Royal College of Nursing; 2009.
• [12]The diabetes medical conditions at school policy pack. [http://medicalconditionsatschool.org.uk/dl/MCP-by-condition/MCP%20DIABETES.pdf webcite]
• [13]Clarke W, Jones T, Rewers A, Dunger D, Klingensmith G: ISPAD Clinical Practice Consensus Guidelines 2009 Compendium. Assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatr Diabetes 2009, 10(Suppl. 12):134-145.
• [14]Rewers M, Pihoker C, Donaghue K, Hanas R, Swift P, Klingensmith G: ISPAD Clinical Practice Consensus Guidelines, Compendium. Assessment and monitoring of glycemic control in children and adolescents with diabetes. Pediatr Diabetes 2009, 10(Suppl. 12):71-81.
• [15]Bangstad H-J, Danne T, Deeb L, Jarosz-Chobot P, Urakami T, Hanas R: ISPAD Clinical Practice Consensus Guidelines 2009 Compendium. Insulin treatment in children and adolescents with diabetes. Pediatr Diabetes 2009, 10(Suppl. 12):82-89.
• [16]Scottish Intercollegiate Guidelines Network: Management of Diabetes: A National Clinical Guideline. No 116. Edinburgh: Scottish Intercollegiate Guidelines Network; 2010.
• [17]NICE: Type 1 Diabetes: Diagnosis and Management of Type 1 Diabetes in Children and Young People. Clinical Guideline 15. RCOG Press: National Institute for Clinical Excellence 2004.
• [18]Robertson K, Adolfsson P, Riddell M, Scheiner G, Hanas R: ISPAD Clinical Practice Consensus Guidelines, Compendium. Exercise in children and adolescents with diabetes. Pediatric Diabetes 2009, 10(Suppl 12):154-168.
• [19]American Diabetes Association: Diabetes Care in the School and Day Care Setting. Position Statement. Diabetes Care 2012, 35(1):S76-S80.
• [20]Program NDE: Helping the Student with Diabetes Suceed. A Guide for School Personnel (NEDP-61). Bethesda, USA: The National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health; 2010.
• [21]Jameson PL: Developing diabetes training programs for school personnel. School Nurse News 2004, 21(4):14-17.
• [22]American Association of Diabetes Educators: Management of children with diabetes in the school setting. Diab Educator 1999, 25(6):2027-2033.
• [23]Jameson P: Helping students with diabetes thrive in school. Newsletter of the American Dietetic Association's Diabetes Care and Eduation Practice Group 2006, 22-29.
• [24]National Collaborating Centre for Women and Children’s Health: Type 1 Diabetes: Diagnosis and Management of Type 1 diabetes in Children and Young People. London: Royal College of Obstetricians and Gynaecologists; 2004.
• [25]Thomas J, Harden A, Oakley A, Oliver S, Sutcliffe K, Rees R, Brunton G, Kavanagh J: Intergrating qualitative research with trials in systematic reviews. BMJ 2004, 328:1010-1012.
• [26]Oliver S, Harden A, Rees R: An emerging framework for including different types of evidence in systematic reviews for public policy. Evaluation 2005, 11(4):428-446.
• [27]EPOC Resources for review authors. [http://epocoslo.cochrane.org/epoc-specific-resources-review-authors webcite]
• [28]Booth A, Brice A: Evidence Based Practice for Information Professionals: A Handbook. London: Facet Publishing; 2003.
• [29]Kirk S, Bone M, Callery P, Milnes L, Pryjmachuk S: Evaluating self-care support for children and young people with long term conditions. Available online at http://www.sdo.nihr.ac.uk/projdetails.php?ref=08-1715-162#: webcite NIHR Service Delivery and Organisation programme, 2010
• [30]Nguyen T, Mason K, Sanders C, Yazdani P, Heptulla R: Targeting blood glucose management in school improves glycemic control in children with poorly controlled type 1 diabetes mellitus. J Pediatr 2008, 143(4):575-578.
• [31]Izquierdo R, Morin P, Bratt K, Moreau Z, Meyer S, Ploutz-Snyder R, Wade M, Weinstock R: School-centered telemedicine for children with type 1 diabetes mellitus. J Pediatr 2009, 155(3):374-379.
• [32]Husband A, Pacaud D, Grebenc K, McKiel E: The effectiveness of a CD Rom in educating teachers who have a student with diabetes. Can J Diab Care 2001, 25(4):286-290.
• [33]Deeks J, Dinnes J, D’Amico R, Sowden A, Sakarovitch , Song F, Petticrew M, Altman D: Evaluating non-randomised intervention studies. Health Technol Assess 2003, 7(27):1-192.
• [34]Centre for Reviews and Dissemination: CRD's guidance on undertaking reviews in health care. University of York CRD; 2009:1-292.
• [35]Engelke M, Guttu M, Warren M, Swanson M: School nurse case management for children with chronic illness: Health, academic, and quality of life outcomes. J Sch Nurs 2008, 24(4):205-214.
• [36]Faro B, Ingersoll G, Fiore H, Ippolito K: Improving students' diabetes management through school-based diabetes care. J Pediatr Health Care 2005, 19(5):301-308.
• [37]Wdowik M, Kendall P, Harris M, Keim K: Development and evaluation of an intervention program: "Control on Campus". Diab Educator 2000, 26(1):95-104.
• [38]Siminerio L, Koerbel G: A diabetes education program for school personnel. Pract Diab Int 2000, 17(6):174-177.
• [39]Cunningham MM, Wodrich D: The effect of sharing health information on teachers' production of classroom accommodations. Psychol Sch 2006, 43(5):553-564.
• [40]Wodrich D: Disclosing information about epilepsy and type 1 diabetes mellitus: the effect on teachers' understandig of classroom behaviour. Sch Psychol Q 2005, 20(3):288-303.
• [41]Bullock L, Libbus M, Lewis S, Gayer D: Continuing education: improving perceived competence in school nurses. J Sch Nurs 2002, 18(6):360-363.
• [42]Bachman J, Hsueh K-H: Evaluation of online education about diabetes management in the school setting. J Sch Nurs 2008, 24(3):151-157.
• [43]Guyatt G, Oxman A, Akl E, Kunz R, Vist G, Brozek J, Norris S, Falck-Ytter Y, Glasziou P, de Beer H, Jaeschke R, Rind D, Meerpohl J, Dahm P, Schunemann HJ: Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011, 64:383-394.
• [44]Rees A, Beecroft C, Booth A: Critical appraisal of the evidence. In The Research Process in Nursing. 6th edition. Edited by Gerrish K, Lacey A. Chichester, UK: Wiley-Blackwell; 2010:85.
• [45]Critical Appraisal Skills Programme checklists. [http://www.sph.nhs.uk/sph-files/casp-appraisal-tools/?searchterm=casp webcite]
• [46]Nabors L, Lehmkuhl H, Christos N, Andreone T: Children with diabetes: perceptions of supports for self-management at school. J Sch Health 2003, 73(6):216-221.
• [47]Bodas P, Marin MC, Amillategui B, Arana R: Diabetes in school. Perceptions of children and adolescents with type 1 diabetes mellitus. Av Odontoestomatol 2008, 24:51-55.
• [48]Peters C, Storch E, Geffken G, Heidgerken A, Silverstein J: Victimization of youth with type-1 diabetes by teachers: relations with adherence and metabolic control. J Child Health Care 2008, 12(3):209-220.
• [49]Lehmkuhl H, Nabors L: Children with diabetes: satisfaction with school support, illness perceptions and HbA1C levels. J Dev Phys Disabil 2008, 20(2):101-104.
• [50]Tang W, Ariyawansa I: Difficulties facing young people with diabetes at school. J Diab Nurs 2007, 27(1):27-31.
• [51]Wang Y, Brown S, Horner S: School-based lived experiences of adolescents with type 1 diabetes: a preliminary study. J Nurs Res 2010, 18(4):258-265.
• [52]Newbould J, Francis S, Smith F: Young people's experiences of managing asthma and diabetes at school. Arch Dis Child 2007, 92(12):1077-1081.
• [53]MacArthur C: Clinical practice. Children, insulin pens and self-injection at school: diabetes management. Prof Care of Mother Child 1996, 6(6):158-160.
• [54]Clay D, Farris K, McCarthy A, Kelly M, Howarth R: Family perceptions of medication administration at school: errors, risk factors, and consequences. J Sch Nurs 2008, 24(2):95-102.
• [55]Schwartz F, Denham S, Heh V, Wapner A, Shubrook J: Lifestyle and behavior. Experiences of children and adolescents with type 1 diabetes in school: survey of children, parents, and schools. Diab Spectrum 2010, 23(1):47-55.
• [56]Hema D, Roper S, Nehring J, Call A, Mandleco B, Dyches T: Daily stressors and coping responses of children and adolescents with type 1 diabetes. Child Care Health Dev 2009, 35(3):330-339.
• [57]Peyrot M: The DAWN Youth WebTalk Study: methods, findings, and implications. Pediatr Diabetes 2009, 10:37-45.
• [58]Carroll AE, Marrero DG: The role of significant others in adolescent diabetes: a qualitative study. Diab Educator 2006, 32:243-252.
• [59]Waller H, Eiser C, Heller G, Knowles J, Price K: Adolescents' and their parents' views on the acceptability and design of a new diabetes education programme: a focus group analysis. Child Care Health Dev 2005, 31(3):283-289.
• [60]Hayes-Bohn R, Neumark-Sztainer D, Mellin A, Patterson J: Adolescent and parent assessments of diabetes mellitus management at school. J Sch Health 2004, 74(5):166-169.
• [61]Wagner J, Heapy A, James A, Abbott G: Brief report: glycemic control, quality of life, and school experiences among students with diabetes. J Pediatr Psychol 2006, 31(8):764-769.
• [62]Amillategui B, Mora E, Calle J, Giralt P: Special needs of children with type 1 diabetes at primary school: perceptions from parents, children, and teachers. Pediatr Diabetes 2009, 10(1):67-73.
• [63]Barnard K, Speight J, Skinner T: Quality of life and impact of continuous subcutaneous insulin infusion for children and their parents. Pract Diab Int 2008, 25(7):278-284.
• [64]Low KG, Masa L, Lehman D, Olshan JS: Insulin pump use in young adolescents with type 1 diabetes: a descriptive study. Pediatr Diabetes 2005, 6:22-31.
• [65]Wilson V, Beskine D: Pump therapy in the management of children and young people with type 1 diabetes. J Diab Nurs 2007, 11(9):352-357.
• [66]Amillategui B, Calle J, Alvarez M, Cardiel M, Barrio R: Identifying the special needs of children with Type 1 diabetes in the school setting. An overview of parents' perceptions. Diabet Med 2007, 24(10):1073-1079.
• [67]Pinelli L, Zaffani S, Cappa M, Carboniero V, Cerutti F, Cherubini V, Chiarelli F, Colombini M, La Loggia A, Pisanti P, Vanelli M, Lorni R: The ALBA project: an evaluation of needs, management, fears of Italian young patients with type 1 diabetes in a school setting and an evaluation of parents' and teachers' perceptions. Pediatria Diab 2011, 12(5):485-493.
• [68]Hellems M, Clarke W: Safe at school: a Virginia experience. Diabetes Care 2007, 30(6):1396-1398.
• [69]Jacquez F, Stout S, Alvarez-Salvat R, Fernandez M, Villa M, Sanchez J, Eidson M, Nemery R, Delamater A: Parent perspectives of diabetes management in schools. Diab Educator 2008, 34(6):996-1003.
• [70]Lewis D, Powers P, Goodenough M, Poth M: Inadequacy of in-school support for diabetic children. Diab Technol Ther 2003, 5(1):45-56.
• [71]Yu LS, Kail R, Hagen JW, Wolters CA: Academic and social experiences of children with insulin-dependent diabetes mellitus. Childrens Health Care 2000, 29(3):189-208.
• [72]Lin H-P, Mu P-F, Lee Y-J: Mothers' experience supporting life adjustment in children with T1DM. West J Nurs Res 2008, 30(1):96-110.
• [73]Ramchandani N, Cantey-Kiser J, Alter C, Brink S, Yeager S, Tamborlane W, Chipkin S: Self-reported factors that affect glycemic control in college students with type 1 diabetes. Diab Educator 2000, 26(4):656-666.
• [74]Balfe M: Alcohol, diabetes and the student body. Health, Risk Soc 2007, 9(3):241-257.
• [75]Balfe M: Diets and discipline: the narratives of practice of university students with type 1 diabetes. Sociol Health Illness 2007, 29(1):136-153.
• [76]Balfe M, Jackson P: Technologies, diabetes and the student body. Health Place 2007, 13(4):775-787.
• [77]Balfe M: The body projects of university students with type 1 diabetes. Qual Health Res 2009, 19(1):128-139.
• [78]Balfe M: Healthcare routines of university students with type 1 diabetes. J Adv Nurs 2009, 65(11):2367-2375.
• [79]Wdowik M, Kendall P, Harris M, Auld G: Expanded health belief model predicts diabetes self-management in college students. J Nutr Educ 2001, 33(1):17-23.
• [80]Wdowik M, Kendall P, Harris M: College students with diabetes: using focus groups and interviews to determine psychosocial issues and barriers to control. Diab Educator 1997, 23(5):558-562.
• [81]Geddes J, McGeough E, Frier B: Young adults with Type 1 diabetes in tertiary education: do students receive adequate specialist care? Diabet Med 2006, 23(10):1155-1157.
• [82]Ravert R: Patient perception, preference and participation: Alcohol management strategies of college students with diabetes. Patient Educ Couns 2009, 77(1):97-102.
• [83]Wilson V: Students' experiences of managing type 1 diabetes. Paediatr Nurs 2010, 22(10):25-28.
• [84]Miller-Hagan RS, Janas BG: Drinking perceptions and management strategies of college students with diabetes. Diabetes Educator 2002, 28(2):233-244.
• [85]Eaton S, Williams R, Bodansky HJ: University students with diabetes. Diabet Med 2001, 18:937-943.
• [86]Greenhalgh S: Improving school teachers' knowledge of diabetes. Prof Nurse 1997, 13(3):150-156.
• [87]Bowen C: Educating teachers in children's illnesses: a study. Nurs Stand 1996, 10(39):33-36.
• [88]Alnasir F, Skerman J: School teachers' knowledge of common health problems in Bahrain. East Mediterr Health J 2004, 10(4–5):537-546.
• [89]Latif Alnasir F: Assessment of knowledge of diabetes mellitus among Bahraini school teachers. Bahrain Med Bulletin 2003, 25(4):172-176.
• [90]Gormanous M, Hunt A, Pope J, Gerald B: Lack of knowledge of diabetes among Arkansas public elementary teachers: implications for dietitians. J Am Diet Assoc 2002, 102(8):1136-1138.
• [91]Tahirovic H, Toromanovic A: How far are physical education teachers from elementary school prepared to help pupils with diabetes while they are at school? Minerva Pediatr 2007, 59(6):767-773.
• [92]Boden S, Lloyd CE, Gosden C, Macdougall C, Brown N, Matyka K: The concerns of school staff in caring for children with diabetes in primary school. Pediatr Diabetes 2011, 13(6):e6-e13.
• [93]Nabors L, Little S, Akin-Little A, Jobst EA: Teacher knowledge of and confidence in meeting the needs of children with chronic medical conditions: pediatric psychology's contribution to education. Psychol Sch 2008, 45(3):217-226.
• [94]Rickabaugh T, Saltarelli W: Knowledge and attitudes related to diabetes and exercise guidelines among selected diabetic children, their parents, and physical education teachers. Res Q Exerc Sport 1999, 70(4):389-394.
• [95]Chmiel-Perzynska I, Derkacz M, Grywalska E, Kowal A, Schabowski J, Nowakowski A: The knowledge about hypoglycaemia among primary school teachers in the Lubelskie Province in Poland. Exp Clin Diabetology 2008, 8(4):157-158.
• [96]Fisher K: School nurses' perceptions of self-efficacy in providing diabetes care. J Sch Nurs 2006, 22(4):223-228.
• [97]Guttu M, Engelke M, Swanson M: Does the school nurse-to-student ratio make a difference? J Sch Health 2004, 74(1):6-9.
• [98]Joshi A, Komlodi A, Arora M: School nurses' perceived barriers to diabetes knowledge, communication and management in children with type 1 diabetes. School Nurs News 2008, 25(3):24-29.
• [99]Nabors L, Troillett A, Nash T, Masiulis B: School nurse perceptions of barriers and supports for children with diabetes. J Sch Health 2005, 75(4):119-124.
• [100]Wagner J, James A: A pilot study of school counselor's preparedness to serve students with diabetes: relationship to self-reported diabetes training. J Sch Health 2006, 76(7):387-392.
• [101]Darby W: The experiences of school nurses caring for students receiving continuous subcutaneous insulin infusion therapy. J Sch Nurs 2006, 22(6):336-344.
• [102]Glenton C, Colvin C, Carlsen , Swartz A, Lewin S, Noyes J, Rashidian A: Barriers and Facilitators to the Implementaion of Lay Health Worker Programmes to improve access to Maternal and Child Health: Qualitative Evidence Synthesis (Review). (Issue 2). Chicester, UK: John Wiley & Sons Ltd; 2013:1-15. [The Cochrane Collaboration]
• [103]Ritchie J, Spencer L: Qualitative data analysis for applied policy research. In Analyzing Qualitative Data. Edited by Bryman A, Burgess R. London: Routledge; 1994:173-194.
• [104]Wodrich DL, Cunningham MM: School-based tertiary and targeted interventions for students with chronic medical conditions: Examples from type 1 diabetes mellitus and epilepsy. Psychol Sch 2008, 45(1):52-62.
• [105]Brener N, Burstein G, DuShaw M, Vernon M, Wheeler L, Robinson J: Health services: results from the School Health Policies and Programs Study 2000. J Sch Health 2001, 71:294-304.
• [106]Lewis I, Lenehan C: Report of the children and young people's health outcomes forum. In Children and young people's health outcomes strategy. London: Council for disabled children; 2012.
• [107]Melton D, Henderson J: Do public schools provide optimal support for children with diabetes. Prev Chronic Dis 2003, 4:A478.
• [108]Emanuele N, Swade T, Emanuele M: Consequences of alcohol use in diabetics. Alcohol Health Res World 1998, 22:211-219.
• [109]Mellinger D: Preparing students with diabetes for life at college. Diabetes Care 2003, 26(9):2675-2678.
• [110]Health Trainers England. http://www.healthtrainersengland.com/ webcite
• [111]Noyes J, Lowes L, Whitaker R, Allen D, Carter C, Edwards R, Rycroft-Malone J, Sharp S, Edwards D, Spencer L, Sylvestre Y, Yeo S, Gregory J: Evidence into practice: the 'EPIC Project' – developing and evaluating a child-centred intervention for diabetes medicine management using mixed methods and a multi-centre randomised controlled trial. Health Serv Deliv Res 2014., 2(8)
• [112]Christie D, Strange V, Allen E: Maximising engagement, motivation and long term changes in a Structured Intensive Education Programme in Diabetes for children, young people and their families: Child and Adolescent Structured Competencies Approach to Diabetes Education (CASCADE). BMC Paediatrics 2009, 9:57. BioMed Central Full Text
• [113]Cooper H: Adolescent Diabetes Needs Assessment Tool Research study (ADNAT). [http://uchoose.wikispaces.com/ webcite]
• [114]Murphy H, Wadham C, Hassler-Hurst J, on behalf of Families and Adolescents Communication and Teamwork Study (FACTS) Group: Randomized trial of a diabetes self-management education and family teamwork intervention in adolescents with Type 1 diabetes. Diab Med 2012, 29:249-254.
• [115]Waller H, Eiser C, Knowles J, Rogers N, Wharmby S, Heller S, Hall C, Greenhalgh S, Tinklin T, Metcalfe C, Millard E, Parkin V, Denial M, Price K: Pilot study of a novel educational programme for 11–16 year olds with type 1 diabetes mellitus: the KICk-OFF course. Arch Dis Childhood 2008, 93:927-931.
• [116]Chaney D, Coates V, Shevlin M, Carson D, McDougall A, Long A, Bunting B: Evaluation of the carbohydrate, insulin collaborative education (CHOICE) programme for young people with type 1 diabetes. Diab Med 2011, 28(Supp 1):1-31.
• [117]Franklin V, Waller A, Pagliari C, Greene A: A randomized controlled trial of Sweet Talk, a text messaging system to support young people with diabetes. Diabet Med 2006, 23:1332-1338.
• [118]Townson J, Gregory J, Cohen D: Delivering Early Care In Diabetes Evaluation (DECIDE): a protocol for a randomised controlled trial to assess hospital versus home management at diagnosis in childhood diabetes. BMC Pediatr 2011, 11:7. BioMed Central Full Text