Key questions

Population

Adults, children and young people with type 1 diabetes

Phenomena of interest

Social and environmental barriers and facilitators of glycaemic control

1. Demographics eg
• ethnicity
• deprivation
• age
• gender
2. Ability to make use of technology
3. Access/availability of interventions
4. Knowledge and information
5. Adherence
6. Health-related quality of life
7. Relationship/satisfaction with health services

Outcomes

Glycaemic control – clinical measures and as described by person with type 1 diabetes

• People’s perception, view or self-reported glycaemic control
• HbA1c
• Hypoglycaemia
• Diabetic ketoacidosis (DKA; number of episodes)

Study type

Quantitative and qualitative studies

Notes

Exclude diet and exercise, and comorbidities

Population

Adults, children and young people with type 1 diabetes

Intervention

• Other education programmes
• Usual care (no education intervention but including SMBG, CGM or flash glucose monitoring)

Comparator

• HbA1c
• Hypoglycaemia - preferably severe hypoglycaemia if reported
• Diabetic ketoacidosis (DKA; number of episodes)
• Hospital admissions
• Hypoglycaemia unawareness
• Health-related quality of life
• Adverse events
• Knowledge
• Adherence to diabetes management (including self management)
• Adherence to education intervention
• Risk-taking behaviour (such as smoking)
• Satisfaction of people with type 1 diabetes and [their] families with the intervention

Outcomes

Quantitative and qualitative studies

Notes

Question adapted from NICE guidelines NG17, NG18

Population

People with type 1 diabetes and their families

Intervention

• Motivational interviewing
• Cognitive behavioural therapy (CBT)
• Counselling
• Family therapy
  • family-based teamwork
  • behavioural family systems therapy
  • multisystemic therapy
• Mentoring
• Peer support

Comparator

• Each other
• Usual care/no treatment

Outcomes

• Diabetes-related emotional distress (including, eg anxiety or depression, PAID scale)
• HbA1c
• Adherence to diabetes management (including self management)
• Health-related quality of life
• Satisfaction of people [with type 1] diabetes and [their] families with the intervention
• School [or work] performance or attendance
• Risk-taking behaviours (such as smoking)
• Adverse events (for example severe hypoglycaemic episodes, diabetic ketoacidosis [DKA] or self harm)

Notes

Question adapted from NICE NG17, NG18

Population

Adults, children and young people with type 1 diabetes.

Intervention

Combined use of:

MDI or CSII, and

SMBG, CGM or FGM

Comparator

All other combinations

Outcomes

• Hypoglycaemia (including severe or nocturnal hypoglycaemia)
• HbA1c (minimum follow up 6 months)
• Adherence to diabetes management (including self management)
• Health-related quality of life
• Cost effectiveness

Secondary outcomes (dependent on achievement of primary outcomes)

• Diabetic ketoacidosis (DKA; number of episodes)
• Satisfaction of individuals with type 1 diabetes with the intervention

Notes

CSII to consider:

• tethered pumps
• patch pumps
• hybrid closed-loop pumps

Cross refer to SHTG advice (Jan 2022)

Population

Adults, children and young people with type 1 diabetes.

Intervention

• HbA1c
• time in target range
• glucose variability (standard deviation around the mean glucose, coefficient of variation, or interquartile range)

Comparator

Each other, or

no comparator (correlation studies)

Outcomes

• Hypoglycaemia
• Hyperglycaemia
• Microvascular complications
• User understanding/confidence in interpreting results

Notes