Short summary

Studies have shown that a different approach to help adolescents with poorly controlled type 1 diabetes is needed and alternative methods such as coaching have been proposed. However, there are very few studies that have investigated the effect of such an intervention. This study is a randomised controlled study investigating whether coaching, offered to adolescents between the age of 15-25 with type 1 diabetes and poor metabolic control , can improve the metabolic control, their self-efficacy, self-determination and quality of life.

Rationale

It is well known that adolescents with type 1 diabetes have difficulties meeting the goals of good metabolic control, resulting in a higher risk of complications and reduced quality of life. In a Danish study, patients with many missed appointments were worse regulated than those attending clinics regularly. However, close follow-up seems to be unhelpful to patients with very poor diabetes regulation.

In addition to medical treatment, focus on psychological problems is recommended, as diabetes self-management can be very challenging requiring both motivation and courage to accept to be and to appear different from others. A meta-analysis found that interventions showing the best results for adolescents with type 1 diabetes were those taking into account emotional, social and family aspects as living with diabetes requires skills to balance practical solutions and emotional conflicts.

Coaching is a method based on the needs of the patient being coached and the purpose of coaching is to help the patient achieve balance in life. It takes into account aspects requested in recent science in treatment of patients with type 1 diabetes.

A pilot study conducted in the Pediatric clinic at Lillebaelt Hospital; Kolding examined the effect of life-coaching offered to 9 adolescents aged 15-19 with elevated HbA1c in spite of  firm commitments from the HCPs. Life coaching was used as a tool and the youngsters were free to choose topics to discuss with a qualified coach. The coaches only had layman's knowledge of diabetes and therefore could not give any advice on treatment. The study showed very promising results with effect both on quantitative and qualitative data. Six out of the nine patients had a decrease in HbA1c and qualitative interviews showed a change in attitude towards diabetes (33). These findings are supported by other studies on coaching as a tool to help patients with type 1 diabetes.

There is only little evidence of the effect of coaching and other than our pilot study another pilot study also showed promising results. In a systematic review of whether life-caching can improve health outcomes, only five citations could be used and only two described HbA1c. However, both studies showed mixed but promising results, especially concerning the patient s that usually does not benefit from intensified interventions. 

It therefore seems relevant to investigate possible benefits of life-coaching.

whether life-coaching offered to adolescents with type 1 diabetes and poor metabolic control can improve HbA1c and/or increase self-efficacy, self-determination and quality of life

The purpose of this study is:

To investigate whether life-coaching offered to adolescents with type 1 diabetes and poor metabolic control can improve HbA1c and/or increase self-efficacy, self-determination and quality of life.

HbA1c will be included in the analysis as well as questionnaires and qualitative interviews.

Description of the cohort

Patients from 5 centres with type 1 diabetes, aged 15-25 years June 2014.

Data and biological material

Questionnaire

CRF (case report forms)

Data from  BCC lab. (HbA1c)

Collaborating researchers and departments

Esbjerg Hospital

• Claus Bogh Juul, PhD

Horsens Hospital

• Diabetes Specialist Nurse Rikke Hvidkjaer

Kolding Hospital

• Consultant Laima Sadauskiene

Fredericia Hospital

• Consultant Hans Gjessing

Department of Pediatrics, Kolding Hospital

• Professor Poul-Erik Kofoed