Major Finding: Adolescents participating in the Web-based intervention had a 0.19-point increase in self-management scores on a 5-point scale, whereas their peers receiving only usual care had a 0.02-point decrease.

Data Source: A randomized trial among 72 adolescents aged 13–17 years with type 1 diabetes.

Disclosures: Dr. Mulvaney reported that she had no conflicts of interest related to the study.

SEATTLE — A Web-based intervention for adolescents with type 1 diabetes helps them better manage their disease, according to findings of a randomized controlled trial.

Adolescents who accessed the Web site, which offered problem-solving activities to help them manage their disease, had a 0.19-point increase in self-management scores on a 5-point scale. Meanwhile, their peers assigned to usual care had a 0.02-point decrease.

In addition, the intervention group had a minimal change in hemoglobin A_1c levels, whereas the level rose in the control group, although this difference was not statistically significant.

“The overall results indicate that the teens thought the Web site was interesting and relevant to them, and the results of change in behavior and A_1c were promising,” lead investigator Shelagh Mulvaney, Ph.D., of Vanderbilt University in Nashville, Tenn., said at the meeting “We plan to expand the content and develop the Web site through a larger randomized trial.”

Children with type 1 diabetes typically have a rise in HbA_1c levels during adolescence, indicating worsening glycemic control, she noted. Part of this is due to the difficulty of reconciling self-management with everything else going on in their lives.

“One recent study estimated that people with type 1 diabetes have to complete 25 tasks a day for adequate self-management,” Dr. Mulvaney observed. “You can imagine that carrying out 25 tasks a day would be difficult, but then add that they have to do it around mealtimes, at school, around their friends, at parties and social gatherings, and you can see how … psychosocial barriers to self-management could come into play.”

Adolescents say such barriers—competing demands, negative emotions, social situations, conflict or tension with specific people, and planning—typically are not well addressed during their regular clinic visits, she added.

For the 11-week trial, investigators enrolled adolescents, aged 13–17 years with type 1 diabetes from a pediatric diabetes clinic. They were randomly assigned in a 1:2 ratio to usual care alone or usual care plus a Web-based intervention (www.yourway.org

The Web site featured multimedia first-person stories that modeled problem-solving techniques for self-management of diabetes, as well as problem-solving cycle activities aimed at helping adolescents apply the skills they were learning to their own lives. It also features a forum to connect with other teens, didactic presentations, and the option to ask experts for advice.

The adolescents were sent weekly e-mail prompts to use the Web site. They received up to $80 for participating in Web site activities and up to $50 for completing questionnaires.

The study results were based on 72 adolescents, 92% of whom were white; average age was 15 (Diabetes Care 2010;33:602–4). The mean time since their diabetes diagnosis was 6 years, and about half were using an insulin pump. The baseline HbA_1c level was 8.2% in the control group and 9.1% in the intervention group.

In the intervention group, seven adolescents never logged onto the Web site, Dr. Mulvaney reported. The rest completed a mean of 5.2 of the 6 stories, and a mean of 1.5 of the 2 problem-solving cycles.

The number of total online activities declined over the study period, likely because the content was no longer updated after the sixth week, she said.

Study outcomes were not statistically significant in intent-to-treat analyses. But in on-treatment analyses, adolescents in the intervention group had an increase of 0.19 points in their total self-management score, as assessed with the 5-point Diabetes Behavior Rating Scale, whereas those in the control group had a decrease of 0.02 points.

In addition, scores on a novel problem-solving scale increased by 0.06 points in the intervention group but decreased by 0.07 points in the control group, and HbA_1c levels fell by 0.01% in the intervention group but rose by 0.33% in the control group. Neither difference was statistically significant.

Adolescents in the intervention group rated the program as excellent (63%) or good (37%). On 5-point scales, they found the stories to be highly relevant (4.7 points) and realistic (4.4 points).

“Our challenges and next steps include expanding the content and increasing the duration of the study, probably to 6 months,” said Dr. Mulvaney.

“We'd like to … increase engagement by increasing interactions between users about problems, so we have created other activities that allow them to comment on each other's problems and provide support to each other directly, which they could do through the forum but they tended not to do.”

In addition, the adolescents expressed interest in some kind of role for their parents, she noted. “So we have designed a parallel parent Web site that we are pilot-testing right now,” she said.

70710_fx1.sml

The site,

Source Courtesy www.yourway.org

Web Site Targets Teens' Type 1 Self-Management