Effect of Diabetes Self-Management Education (DSME) with and without Motivational Interviewing (MI) on Glycemic Control among Children and Adolescents with Type 1 Diabetes Mellitus: A Randomized Controlled Trial

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Ornsuda Lertbannaphong
Pimonsri Hantanasiriskul
Pornpimol Kiattisakthavee
Sunsanee Ruangson
Nantawat Sitdhiraksa
Jeerunda Santiprabhob


Background: Type 1 diabetes mellitus (T1DM) is a chronic disease that is difficult to control. Motivational interviewing (MI) is a collaborative style of communication that was designed to strengthen a person’s motivation and commitment to change and improve. We hypothesized that applying MI to diabetes care would lead to improved glycemic control and improved diabetes self-care behavior.

Methods: Subjects were T1DM patients aged 10-18 years with HbA1C ≥8% that were recruited from the Outpatient Diabetes Clinic during October 2016 - March 2017. Subjects were randomized into the diabetes self-management education (DSME) or DSME plus MI groups. HbA1C levels, diabetes knowledge test, and diabetes self-care behavioral questionnaire were performed.

Results: Thirty-five patients (17 DSME, 18 DSME + MI) completed the study. Baseline HbA1C was not significantly different between groups. At the end of the study, HbA1C levels were not significantly different within or between groups. From pre-intervention to post-intervention, diabetes knowledge scores were significantly increased, and self-care behavioral scores were significantly increased for dietary control and medical taking. Transition to the stages of change action stage was increased from 0 to 12 persons.

Conclusions: The effectiveness of MI on glycemic control was not found to be statistically significant at 6 months. However, continuation of DSME in T1DM patients is necessary for improving diabetes knowledge and care. Further study in a larger sample size with longer duration of MI and follow-up is needed to conclusively establish the value of MI on glycemic control in pediatric T1DM.


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Lertbannaphong, O. ., Hantanasiriskul, P. ., Kiattisakthavee, P. ., Ruangson, S. ., Sitdhiraksa, N. ., & Santiprabhob, J. . (2021). Effect of Diabetes Self-Management Education (DSME) with and without Motivational Interviewing (MI) on Glycemic Control among Children and Adolescents with Type 1 Diabetes Mellitus: A Randomized Controlled Trial. Siriraj Medical Journal, 73(10). https://doi.org/10.33192/Smj.2021.82
Original Article


1. Ziegler R, Heidtmann B, Hilgard D, Hofer S, Rosenbauer J, Holl R. Frequency of SMBG correlates with HbA1c and acute complications in children and adolescents with type 1 diabetes. Pediatr Diabetes 2011;12:11-7.
2. Miller KM, Beck RW, Bergenstal RM, Goland RS, Haller MJ, McGill JB, et al. Evidence of a strong association between frequency of self-monitoring of blood glucose and hemoglobin A1c levels in T1D exchange clinic registry participants. Diabetes Care 2013;36:2009-14.
3. Patjamontri S, Khemaprasit K, Santiprabhob J, Nakavachara P, Lertbannaphong O, Kiattisakthavee P, et al. The effect of early diabetes self-management education on glycemic control in children with type 1 diabetes. Southeast Asian J Trop Med Public Health 2018;49:304-13.
4. Rewers MJ, Pillay K, de Beaufort C, Craig ME, Hanas R, Acerini CL, et al. ISPAD Clinical Practice Consensus Guidelines 2014. Assessment and monitoring of glycemic control in children and adolescents with diabetes. Pediatr Diabetes 2014;15 Suppl 20:102-14.
5. Miller WR, Rollnick S. Meeting in the middle: motivational interviewing and self-determination theory. Int J Behav Nutr Phys Act 2012;9:25.
6. Li L, Zhu S, Tse N, Tse S, Wong P. Effectiveness of motivational interviewing to reduce illicit drug use in adolescents: a systematic review and meta-analysis. Addiction 2016;111:795-805.
7. Lai DT, Cahill K, Qin Y, Tang JL. Motivational interviewing for smoking cessation. Cochrane Database Syst Rev 2010:CD006936.
8. Lindson-Hawley N, Thompson TP, Begh R. Motivational interviewing for smoking cessation. Cochrane Database Syst Rev 2015:CD006936.
9. Erickson SJ, Gerstle M, Feldstein SW. Brief interventions and motivational interviewing with children, adolescents, and their parents in pediatric health care settings: a review. Arch Pediatr Adolesc Med 2005;159:1173-80.
10. Jones A, Gladstone BP, Lubeck M, Lindekilde N, Upton D, Vach W. Motivational interventions in the management of HbA1c levels: a systematic review and meta-analysis. Prim Care Diabetes 2014;8:91-100.
11. Sindelar HA, Abrantes AM, Hart C, Lewander W, Spirito A. Motivational interviewing in pediatric practice. Curr Probl Pediatr Adolesc Health Care 2004;34:322-39.
12. Suarez M, Mullins S. Motivational interviewing and pediatric health behavior interventions. J Dev Behav Pediatr 2008;29:417-28.
13. Santiprabhob J, Kiattisakthavee P, Likitmaskul S, Chaichanwattanakul K, Wekawanich J, Dumrongphol H, et al. Glycemic control, quality of life and self-care behavior among adolescents with type 1 diabetes who attended a diabetes camp. Southeast Asian J Trop Med Public Health 2012;43:172-84.
14. Tachanivate P. Factors influencing quality of life in adolescents with type 1 diabetes [Thesis]. Bangkok, Thailand: Mahidol University; 2007.
15. DAFNE Study Group. Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial. BMJ 2002;325:1-6.
16. Spiegel G, Bortsov A, Bishop FK, Owen D, Klingensmith GJ, Mayer-Davis EJ, et al. Randomized nutrition education intervention to improve carbohydrate counting in adolescents with type 1 diabetes study: is more intensive education needed? J Acad Nutr Diet 2012;112:1736-46.
17. Chiang JL, Kirkman MS, Laffel LM, Peters AL. Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes Care 2014;37:2034-54.
18. Hathout EH, Fujishige L, Geach J, Ischandar M, Maruo S, Mace JW. Effect of therapy with insulin glargine (lantus) on glycemic control in toddlers, children, and adolescents with diabetes. Diabetes Technol Ther 2003;5:801-6.
19. Likitmaskul S, Wacharasindhu S, Rawdaree P, Ngarmukos C, Deerochanawong C, Suwanwalaikorn S, et al. Thailand diabetes registry project: type of diabetes, glycemic control and prevalence of microvascular complications in children and adolescents with diabetes. J Med Assoc Thai 2006;89 Suppl 1:S10-6.
20. Dejkhamron P, Santiprabhob J, Likitmaskul S, Deerochanawong C, Rawdaree P, Tharavanij T, et al. Type 1 diabetes management and outcomes: A multicenter study in Thailand. J Diabetes Investig . 2021 Apr;12(4):516-526.
21. Channon SJ, Huws-Thomas MV, Rollnick S, Hood K, Cannings-John RL, Rogers C, et al. A multicenter randomized controlled trial of motivational interviewing in teenagers with diabetes. Diabetes Care 2007;30:1390-5.
22. Waller G. The myths of motivation: time for a fresh look at some received wisdom in the eating disorders? Int J Eat Disord 2012;45:1-16.
23. Santiprabhob J, Likitmaskul S, Kiattisakthavee P, Weerakulwattana P, Chaichanwattanakul K, Nakavachara P, et al. Glycemic control and the psychosocial benefits gained by patients with type 1 diabetes mellitus attending the diabetes camp. Patient Educ Couns 2008;73:60-6.
24. Lange K, Swift P, Pankowska E, Danne T. ISPAD Clinical Practice Consensus Guidelines 2014. Diabetes education in children and adolescents. Pediatr Diabetes 2014;15 Suppl 20:77-85.

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