Effects of a structured educational intervention on metabolic control of type-1 diabetes mellitus patients

  • Bernie Endyarni
  • Jose RL Batubara
  • I Boediman
Keywords: type-1 diabetes, HbA1c, metabolic control, education


Background Children with type-1 diabetes face not only short-
term complications but also long-term microvascular and
macrovascular complications. Therefore, a continuing medical care
and education to reach blood glucose near normal range is abso-
lutely required. An addition of behavioral educational intervention
to intensive diabetes management resulted in improved metabolic
control and quality of life.
Objective To determine the effects of a structured educational
intervention to parents and patients with type-1 diabetes mellitus
on their knowledge and patient metabolic control.
Methods In this interventional study with pretest-posttest design
at Department of Child Health, Medical School, University of Indo-
nesia, a total of 21 patients with the age between 8 and 18 years
and their parents were assigned to follow a structured educational
program over period of 6 months. During the 6 intervention ses-
sions, some procedures were applied: obtaining HbA1c at initial,
3 rd and 6 th month using HPLC procedure, classroom teaching pro-
gram, small group discussions, role-playing and pre-posttests.
Results The mean HbA1c level in the 21 children and adoles-
cents at initial, 3 rd and 6 th month were 10.05% (SD 2.67%), 10.28%
(SD 2.23%) and 10.01% (SD 2.67%), which showed no significant
changes (P>0.05). After 6 educational sessions, the result showed
significant changes in both parents’ (P<0.05) and patients’ knowl-
edge (P<0.05). Patients’ diabetes-related knowledge had a mod-
erate correlation (r=-0.632; P=0.02) , but parents’ diabetes-related
knowledge had no significant correlation (r=-0.348; P=0.122) with
patient mean HbA1c level.
Conclusion A structured educational intervention used in this study
is able to improve parents’ and patients’ diabetes-related knowl-
edge significantly. Patients’ diabetes-related knowledge had a sig-
nificant correlation with metabolic control

Author Biographies

Bernie Endyarni
Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.
Jose RL Batubara
Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.
I Boediman
Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.


1. The expert committee on the diagnosis and classifica-
tion of diabetes mellitus. Report of the Expert Com-
mittee on the Diagnosis and Classification of Diabetes
Mellitus. Diabetes care 2001;24:S5-18.
2. Laron Z, Karp M. Diabetes mellitus in children and
adolescents. In: Bertrand J, Rappaport R, Sizonenko P,
editors. Pediatric endocrinology: Physiology, patho-
physiology, and clinical aspects. 2nd ed. Baltimore:
Williams & Wilkins; 1993. p. 597-617.
3. Batubara JRL. Penatalaksanaan diabetes pada anak.
In: Pusat diabetes dan lipid RSUPNCM FKUI.
Penatalaksanaan diabetes melitus terpadu. 1st ed.
Jakarta: Aksara Buana; 1999. p. 149-56.
4. UKK Endokrinologi. Konsensus nasional pengelolaan dia-
betes melitus tipe-1 di Indonesia. Jakarta; 2000. p. 5-45.
5. Sperling MA. Diabetes mellitus in children. In:
Behrman RE, Kliegman RM, Jenson HB, editors.
Nelson textbook of pediatrics. 16th ed. Philadelphia:
W.B. Saunders; 2000. p. 1767-86.
6. Batubara JRL. Audit of childhood diabetes control in
Indonesia. Paediatr Indones 2002;42:280-6.
7. Batubara JRL, Firmansyah A, Mansyoer R, Tridjaja B,
Pulungan AB. Clinical and laboratory features of chil-
dren with insulin dependent diabetes mellitus of more
than two years. Paediatr Indones 2001;41:255-9.
8. Allen C, LeCaire T, Palta M, Daniels K, Meredith M,
D’Alessio DJ. Risk factors for frequent and severe hy-
poglycemia in type 1 diabetes. Diabetes care 2001;
9. Silverstein J, Klingensmith G, Copeland K, Plotnick L,
Kaufman F, Laffel L, et al. Care of children and adoles-
cents with type 1 diabetes, a statement of the American
Diabetes Association. Diabetes care 2005;28:186-212.
10. American diabetes association. Standards of medical
care for patients with diabetes mellitus. Diabetes care
11. The diabetes control and complications trial
(DCCT) research group. The effect of intensive
treatment of diabetes on the development and pro-
gression of long-term complications in insulin-de-
pendent diabetes mellitus. N Engl J Med 1993;
12. Grey M, Boland EA, Davidson M, Li J, Tamborlane
WV. Coping skills training for youth with diabetes
mellitus has long-lasting effects on metabolic control
and quality of life. J Pediatr 2000;137:107-13.
13. Hoey H, Aanstoot HJ, Chiarelli F, Daneman D, Danne
T, Dorchy H, et al. Good metabolic control is associ-
ated with better quality of life in 2,101 adolescents with
type 1 diabetes. Diabetes care 2001;24:1923-8.
14. Bauman IG, Strugger M, Flaherty BP, McEvoy RC. Meta-
bolic control and quality-of-life self-assessment in ado-
lescents with IDDM. Diabetes care 1998;21:915-8.
15. Kaplan RM, Chadwick MW, Schimmel LE. Social
learning intervention to promote metabolic control in
type I diabetes mellitus: Pilot experiment results. Dia-
betes care 1985;8:152-5.
16. Lockington TJ, Powles S, Meadows KA, Wise PH. At-
titudes, knowledge and blood glucose control. Diabet
Med 1989;6:309-13.
17. Bloomgarden ZT, Karmally W, Metzger MJ, Brothers
M, Nechemias C, Bookman J, et al. Randomized, con-
trolled trial of diabetic patient education: Improved
knowledge without improved metabolic status. Dia-
betes care 1987;10:263-72.
18. LeBlanc LA, Goldsmith T, Patel DR. Behavioral as-
pects of chronic illness in children and adolescents.
Pediatr Clin North Am 2003;50.
19. Schumacher EP, Jacksonville S. Diabetes self-management
education: The key to living well with diabetes. Cited 2005
April 7. Available from: http://www.dcmsonline.org/lax-medi-
cine/2005 journals /Diabetes/diab05j-pt-education.pdf.
20. Pieber TR, Brunner GA, Schnedi WJ, Schattenberg S,
Kaufmann P, Krejs GJ. Evaluation of a structured out-
patient group education program for intensive insulin
therapy. Diabetes care 1995;18:625-30.
21. Cardwell CR, Patterson CC, Allen M, Carson DJ. Dia-
betes care provision and glycaemic control in North-
ern Ireland: A UK regional audit. Arch Dis Child
22. Dorchy H, Roggemans MP, Willems D. Glycated he-
moglobin and related factors in diabetic children and
adolescents under 18 years of age: A Belgian experi-
ence. Diabetes care 1997;20:2-6.
23. Mendez FJ, Belendez M. Effects of a behavioral inter-
vention on treatment adherence and stress manage-
ment in adolescents with IDDM. Diabetes care
24. Haller MJ, Stalvey MS, Silverstein JH. Predictors of
control of diabetes: Monitoring may be the key. J Pediatr
How to Cite
Endyarni B, Batubara J, Boediman I. Effects of a structured educational intervention on metabolic control of type-1 diabetes mellitus patients. PI [Internet]. 18Oct.2016 [cited 3Dec.2023];46(6):260-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/954
Received 2016-10-17
Accepted 2016-10-17
Published 2016-10-18