Benefits, implementation and sustainability of innovative paediatric models of care for children with type 1 diabetes : A systematic review

Journal article


Carrigan, Ann, Meulenbroeks, Isabelle, Sarkies, Mitchell, Dammery, Genevieve, Halim, Nicole, Singh, Nehal, Lake, Rebecca, Davis, Elizabeth, Jones, Timothy W., Braithwaite, Jeffrey and Zurynski, Yvonne. (2024). Benefits, implementation and sustainability of innovative paediatric models of care for children with type 1 diabetes : A systematic review. BMC Pediatrics. 24(1), p. Article 502. https://doi.org/10.1186/s12887-024-04945-2
AuthorsCarrigan, Ann, Meulenbroeks, Isabelle, Sarkies, Mitchell, Dammery, Genevieve, Halim, Nicole, Singh, Nehal, Lake, Rebecca, Davis, Elizabeth, Jones, Timothy W., Braithwaite, Jeffrey and Zurynski, Yvonne
Abstract

Background and aim
The evidence about the acceptability and effectiveness of innovative paediatric models of care for Type 1 diabetes is limited. To address this gap, we synthesised literature on implemented models of care, model components, outcomes, and determinants of implementation and sustainability.

Methods
A systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Database searches of Medline, CINAHL, EMBASE and Scopus were conducted. Empirical studies focused on Type 1 diabetes paediatric models of care, published from 2010 to 2022 in English were included.

Results
Nineteen extant studies reported on models and their associations with health and psychosocial outcomes, patient engagement with healthcare, and healthcare costs. Thirteen studies described multidisciplinary teamwork, education and capacity building that supported self-care. Four studies involved shared decision making between providers and patients, and two discussed outreach support where technology was an enabler. Fourteen studies reported improvements in health outcomes (e.g. glycaemic control), mostly for models that included multidisciplinary teams, education, and capacity building (11 studies), outreach support or shared care (3 studies). Four studies reported improvements in quality of life, three reported increased satisfaction for patients and carers and, and one reported improved communication. Four of five studies describing shared care and decision-making reported improvements in quality of life, support and motivation. Outreach models reported no negative outcomes, however, accessing some models was limited by technological and cost barriers. Eight studies reported on model sustainability, but only half reported implementation determinants; none reported applying a theoretical framework to guide their research.

Conclusion
Some health and psychosocial benefits were associated with newer models. To address knowledge gaps about implementation determinants and model sustainability, longitudinal studies are needed to inform future adoption of innovative models of care for children with Type 1 diabetes.

Keywordstype 1 diabetes; children; families; model of care; innovation; person-centred care; multidisciplinary teamwork; health outcomes
Year2024
JournalBMC Pediatrics
Journal citation24 (1), p. Article 502
PublisherBiomed Central Ltd
ISSN1471-2431
Digital Object Identifier (DOI)https://doi.org/10.1186/s12887-024-04945-2
PubMed ID39103837
Scopus EID2-s2.0-85200466886
PubMed Central IDPMC11299261
Open accessPublished as ‘gold’ (paid) open access
Page range1-15
FunderJDRF Australia
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online05 Aug 2024
Publication process dates
Accepted15 Jul 2024
Deposited06 May 2025
Grant ID5_SRA_2021_1088_m-X
Additional information

© The Author(s) 2024.

This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it.The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

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