medwireNews: The Youth Empowerment Skills (YES) program, a novel psychoeducational intervention for adolescents and young adults with type 1 diabetes, may help to improve glycemic control and reduce acute diabetes emergencies in this challenging group of patients, research shows.
Speaking at the virtual ADA 80th Scientific Sessions, Dulmini Kariyawasam, from Guy’s and St Thomas’ NHS Foundation Trust in London, UK, said that in addition to improved outcomes, the YES program, which was tested in a cohort with a high proportion of non-White participants from deprived backgrounds, “encourages a more positive attitude towards living with diabetes.”
The YES program was developed on the basis of responses from focus groups that asked patients about the emotional impact of diabetes, as well as what they wanted to learn, from whom, and in what setting.
Kariyawasam said there was a strong need for peer support and a “clear message” that the individuals did not want to learn in a hospital-based setting.
Following the focus groups, the YES program was co-created with young people to include three main learning methods: simulation; group-based learning; and physical activities, which were included to improve confidence, Kariyawasam pointed out.
The course was delivered by trained peer-facilitators, with a youth worker supporting engagement, over 3 short days at local youth centers. It covers areas such as the psychosocial impact of diabetes, routine, relationships and diabetes, and healthy eating.
The simulation day includes scenarios such as a clinic consultation and managing hypoglycemia or a sick day at home. The day also includes a physical limitation suit simulation that obstructs vision and reduces mobility in the hands and feet, giving an opportunity to discuss diabetes complications.
So far, 49 individuals aged 14–20 years (mean 17.3 years) have taken part in the program and completed 12 months of follow-up. Just under half (47%) were White, 46% were Afro-Caribbean, and 7% were Asian. The majority (65%) had high levels of deprivation.
At baseline, the mean glycated hemoglobin level was 10.4%. By 12 months, it had fallen significantly to 9.7%, with almost half (48%) of patients improving by more than 0.5%, which Kariyawasam said is clinically significant.
Diabetic ketoacidosis admissions also fell significantly, with 15 fewer admissions in the year after, versus the year before YES (27 vs 12). Hypoglycemia admissions increased from two in the year before YES to four in the year after, giving a net reduction in total unplanned hospital admissions of 13, or 44.8%.
Qualitative follow-up questionnaires and interviews at 6 weeks post-intervention showed that the intervention improved focus on diet and blood sugar levels, general diabetes care, and communication with friends about diabetes.
Participants also reported a more positive mindset regarding their diabetes, with more awareness and acceptance of the condition.
Kariyawasam concluded: “Young people with type 1 diabetes face complex problems and psychosocial factors play a major part in how they look after their diabetes.”
She added: “The YES program uses innovative teaching techniques like simulation and encourages a more positive and accepting attitude towards living with diabetes.”
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