Sugarsquare. Focus on the Adolescent: Digital Treatment of Type 1 Diabetes Through the Internet
The treatment of diabetes is multidisciplinary. Alignment of care of the various professional disciplines is, however, not always optimal. This can lead to confusion about treatment interventions and behavioral advices. In adolescence, good fine-tuned care is of extreme importance because of the difficulties in regulation of the disease in this phase of life (Snoek, 2004). These difficulties are due to biological changes but also to socio-psychological developmental changes. The adolescents' psychological development demands more autonomy and responsibility for the diabetes (care) by the adolescent. The social development can conflict with the treatment regime, because of the adolescents' social needs (ADA, 2001; Houdijk, 1998; Snoek, 2004). In this study the investigators assess whether an interactive website, on which adolescents with diabetes and their treatment team can communicate, leads to better alignment of care and better control over the disease.
The diabetes has great impact on the adolescents' everyday life. Finding a balance between more autonomy, participating in social life with (healthy) peers and control of the disease is difficult and seems to act as a thread during this phase in life.
This can lead to questions and uncertainty at any given moment. The interactive website provides the adolescent access to information and to his or her individual treatment plan and advices fitted to his or her condition and life. The adolescent can pose questions at any given moment through the online forum and their personal treatment page. Since the treatment team answers the question within a day, fit between diabetes care and adolescents' everyday life is optimized.
Does an online interactive treatment environment, on which adolescents with diabetes can communicate with their treatment team, lead to better fit of care and to better disease control?
|Study Design:||Allocation: Randomized
Masking: Open Label
Primary Purpose: Supportive Care
|Official Title:||Sugarsquare. Focus on the Adolescent: Digital Treatment of Type 1 Diabetes Through the Internet|
- Patients' Evaluation of Quality of Care [ Time Frame: T0: baseline (1 month prior to acces to intervention); T1: (6 months following T0); T2: (12 months following T0). ] [ Designated as safety issue: No ]Participants' appreciation of our diabetes care was assessed using the Patients' Evaluation of Quality of Diabetes care (PEQ-D; Pouwer & Snoek, 2002). This questionnaire consists of 14 items, such as: 'The amount of information I receive from the doctor is…'. The adolescent is asked to answer by means of a 5-point lykert scale varying from 1) bad to 5) excellent.
- Health Related Quality of Life [ Time Frame: T0: baseline (1 month prior to acces to intervention); T1: (6 months following T0); T2: (12 months following T0). ] [ Designated as safety issue: No ]Health-related quality of life was measured by means of the PedsQl 3.0 diabetes module (Varni, 2004). The Dutch translation was used, which shows good psychometric properties for clinical application in pediatric diabetes care (de Wit, 2008). The questionnaire consists of 28 items and can be subdivided into five subscales; diabetes symptoms, treatment barriers, treatment adherence, worry, and communication. Example of item: 'I feel hungry' (subscale diabetes symptoms). Al items can be answered using a 5-point lykert scale, varying from 0 (never) to 4 (almost always).
- Adolescents' disease knowledge [ Time Frame: T0: baseline (1 month prior to acces to intervention); T1: (6 months following T0); T2: (12 months following T0). ] [ Designated as safety issue: No ]Diabetes knowledge was measured using the Diabetes Knowledge Questionnaire (Fitzgerald, 1998). This questionnaire has shown to have good psychometric properties (Fitzgerald, 1998). The questionnaire was translated in Dutch especially for this study. The final Dutch version, DKT-NL, consisted of 21 multiple choice questions, such as 'sings of ketoacidosis include… '. Possible answers were: a) shakiness, b) sweating, c) vomiting (right answer), d) low blood glucose .
- Confidence In Diabetes Selfcare [ Time Frame: T0: baseline (1 month prior to acces to intervention); T1: (6 months following T0); T2: (12 months following T0). ] [ Designated as safety issue: No ]Participants' self-efficacy was determined through use of the Confidence In Diabetes Selfcare questionnaire (CIDS; van de ven, 2004). The questionnaire contains 20 items, all referring to the perceived ability to perform diabetes self-care tasks. All items are preceded by "I believe I can… ," and can be answered on a 5-point lykert scale, varying from 1) "No, I am sure I cannot" to 5) "Yes, I am sure I can"). An example is "I believe I can… adjust my insulin when I am sick".
- Glycemic control (HbA1c) [ Time Frame: T0: baseline (1 month prior to acces to intervention); T1: (6 months following T0); T2: (12 months following T0). ] [ Designated as safety issue: No ]Patients' Glycemic control was derived from their files. 'Old' HbA1c values were converted to new HbA1c values using the calculator of the Dutch Diabetes Federation (NDF, 2010). New HbA1c values were used in the analyses.
- Degree of use of intervention [ Time Frame: T1 (6 months following start of intervention) ] [ Designated as safety issue: No ]The degree of use of our intervention was measured by frequency of use of adolescents of different applications. We therefore logged all action of adolescents on Sugarsquare. Examples of variables are number of page views, number of posted messages on the forum, number of attended chat sessions and number of started discussions with professional caregivers. Table 3 gives insight in all actions included in the analysis.
|Study Start Date:||February 2009|
|Study Completion Date:||November 2010|
|Primary Completion Date:||April 2010 (Final data collection date for primary outcome measure)|
Behavioral: Internet intervention
|Children's Diabetes Center Nijmegen|
|Nijmegen, Gelderland, Netherlands, Postbus 9015; 6500 GS|
|Principal Investigator:||Emiel Boogerd, MSc.||Radboud University Nijmegen, Medical Center|
|Principal Investigator:||Chris Verhaak, Dr.||Radboud University Nijmegen, Medical Center|
|Principal Investigator:||Kees Noordam, Dr.||Radboud University Nijmegen, Medical Center|