Providing optimal service delivery for children and adolescents with type 1 diabetes: a systematic review

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The purpose of this systematic review was (1) to perform a comprehensive examination of the literature to identify aspects of service delivery which are associated with improved glycaemic control in young people with type 1 diabetes, and (2) to identify gaps in the current literature and suggest areas for future research.The online medical databases Medline, Embase, Psycinfo and Cinahl were searched using a series of keywords. We reviewed randomised controlled trials and cross-sectional, comparison and retrospective audit studies from 1980 to December 2007 which involved children, adolescents and young adults with type 1 diabetes. In total, 540 studies were screened for inclusion, with 68 papers retrieved for further analysis 23 of which were retained for inclusion in the review.The service delivery indicators identified in the review which have an impact on glycaemic control in young people with type 1 diabetes include access to specialist care, number of clinic visits attended, access to care from a multidisciplinary diabetes team and regular telephone contact.This review confirmed that various aspects of paediatric diabetes service delivery do impact on the glycaemic control of children and adolescents with type 1 diabetes. It has also identified the need for studies to examine further the complex interplay of multiple aspects of service delivery, including the impact of a family-centred model of care, on glycaemic control.

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