The quest for glycemic control in children with type 1 diabetes. Can a parenting intervention such as Triple P help?

Parenting interventions such as Triple P have been shown to reduce mental health problems in children. But can a parenting intervention moderate the impact of type 1 diabetes in children as well as improve their mental health and wellbeing?

Two separate studies into the effects of Triple P – one conducted by a team across Melbourne, the other by an international team from Manchester and the University of Queensland’s Parenting and Family Support Centre – suggest these research questions are definitely worth pursuing.

The Melbourne randomised controlled trial (RCT), published in Pediatric Diabetes last year, tested whether Triple P could reduce or prevent mental health problems and improve glycemic control in children with type 1 diabetes.

Meticulous glycemic control is regarded as crucial in preventing serious complications for people diagnosed with type 1 diabetes.

If not managed properly, type 1 diabetes can lead to serious short-term consequences, such as extremely low and high blood glucose levels, both of which can be fatal. Long-term complications include blindness and damage to kidneys, nerves and heart.

Unfortunately, day to day management of type 1 diabetes is complicated and onerous, especially for teens who would prefer someone “just invent a cure already’’ and parents struggling with behaviour problems in their kids.

The study by Westrupp et al (2014) was conducted by an interdisciplinary team from the Murdoch Children’s Research Institute, the Royal Children’s Hospital, the School of Psychology and the Department of Paediatrics at the University of Melbourne. Researchers offered families with children aged from four to 12 with type 1 diabetes access to Standard Triple P, which involves attending ten individual one-hour sessions. The control group was care as usual.

The holy grail of a significant effect on glycemic control remained elusive. However, significant impacts for other outcomes were achieved for children identified as having elevated behaviour problems.

“Our findings consistently showed that effects of Triple P were stronger where parents reported pre-existing child mental health problems; with improvements evident in child behaviour, parent mental health, parenting skills, and diabetes family conflict at 3 months following the intervention,’’ the study reports. “Some of these intervention effects were sustained to 12 months, where parent anxiety and stress remained lower and parenting competency was enhanced.’’

Given that Westrupp et al point to emerging evidence of a two-way link between psychological wellbeing and glycemic control in children with type 1 diabetes, the outcomes were encouraging. As the authors point out:

“It is important to note that the average glycemic control was in the recommended range for this age-group, so it is also possible that there was limited room for improvement in this sample of children.’’

Web-based study shows effects

While the Melbourne research investigated the effect of Standard Triple P on families with children diagnosed with type 1 diabetes, the Manchester study − published in the Journal of Paediatric Psychology in 2013 − was an RCT which looked at whether the Self-Directed Teen Triple P workbook (10 × 1 hr modules) plus a chronic illness tip sheet could reduce diabetes-related family conflict and parental stress.

The study was entirely web-based and used a text-messaging system to keep families on track.

Participants in the Manchester intervention group reported significantly improved diabetes-related family conflict problems after participating in Triple P than parents in usual care. However, no significant difference was found between groups on measure of parental stress, or on glycemic control.

In discussing the context of their research, Doherty et al (2013) suggested that interventions which had been specifically tailored to address key condition issues such as diabetes could demonstrate significantly improved rates of treatment adherence and glycemic control (Wysocki, Greco, Harris, & White, 2000; Wysocki et al., 2006).

Considering the numbers of adolescents struggling to keep their blood sugar under control, and evidence that family functioning could have an impact on glycemic control targets, the authors argued there was “a clear need for a wider-reaching family intervention (with condition components) to support these families’’.

Can a brief intervention work?

Since research (Dabadghao et al, 2001; Cameron, 2003) indicates that having good routines and practices in place at a younger age might help reduce problems later in adolescence and adulthood, a team at the University of Queensland’s Parenting and Family Support Centre is investigating a brief tailored intervention for parents of young children with type 1 diabetes.

“Because diabetes management can be so demanding, many parents struggle with finding the time to attend programs,’’ researcher Aditi Lohan said.

“We think that a briefer version might actually encourage more parents to participate in the program. If effective, this version might also help parents deal with these time issues through the use of positive parenting techniques such as planning ahead.

“Such an intervention should also be relatively easy to integrate into the medical settings, perhaps delivered directly through hospitals at the family’s regular clinic appointments.’’