A systematic review of parent/peer-based group interventions for adolescents with type 1 diabetes: interventions based on theoretical/therapeutic frameworks

Objective: Although interventions which provide psychosocial support can have a positive impact on diabetes self-care, the impact of family/peer- and theory-based interventions has not yet been clearly identified. This systematic review investigates the randomised controlled trials (RCTs) employing family/peer-based interventions (based on theoretical/therapeutic frameworks) which aim to improve adolescents' glycaemic control, psychosocial and/or behavioural functioning. Methods: The Cochrane Library, database of systematic reviews, database of abstracts of reviews of effectiveness and Health Technology Assessment database were searched (from start date until February 2016) for any previously conducted systematic reviews. Seventeen RCTs/interventions were included. The literature was also identified by contacting the leading researchers. Glycaemic control was measured by HbA(1c) and psychosocial functioning by measures of self-care, knowledge and communication, collaboration/teamwork, quality of life, problem solving, social functioning and family functioning. Only those interventions which reported the use of theories/therapies to manage type 1 diabetes and other psychosocial issues among adolescents (aged 12-17) were included in the present review. Data summarising the key features of the interventions was extracted from each article. Where possible, the effect sizes were calculated. Results: The effect sizes could be computed for HbA1c in six of the 17 interventions. The overall outcomes indicated that interventions including parents have a small to large effect size on a variety of diabetes management and psychosocial outcomes. This review identified interventions, mostly including parents and rarely including peers. Conclusion: The results of this systematic review demonstrate that multicomponent interventions may be more successful for adolescents than ones that just focus on one aspect. Effectiveness is also greater if they demonstrate inter-relatedness with the various aspects of diabetes management. Short-term behavioural approach-based interventions promote improvements in parent/adolescent relationships. Outreach home-based interventions could be a more accessible alternative for intervening with families than office/hospital-based interventions. This approach may also be more acceptable to adolescents and their families. There is a need to develop evaluated interventions for adolescents involving parents. Development should involve stakeholders (ie, adolescents, their families and healthcare professionals) to co-design potentially cost-effective and feasible interventions in the context of NHS diabetes services.