Maximising engagement, motivation and long term change in a structured intensive education programme in diabetes for children, young people and their families: child and adolescent structured competencies approach to diabetes education
A structured education programme is teaching children with diabetes, aged 8 to 16, how to adjust their own insulin doses, eat normally, and handle everyday challenges like exercise or illness, alongside their families. This matters because managing type 1 diabetes in childhood is relentless, and many young people struggle to maintain good blood sugar control, which raises their long-term risk of complications such as kidney failure, blindness, and heart disease. Existing education programmes often fail to keep children engaged or to produce lasting change. The CASCADE trial tests whether a competency-driven, motivational approach—delivered by NHS staff already in post—can improve HbA1c levels, quality of life, and self-management, and whether it is cost-effective for the NHS. If the programme works, even a small reduction in HbA1c could reduce long-term complications and save the health service money. The trial will also measure whether improvements are maintained at 24 months, and model the costs of training and delivery across the wider NHS. This is an applied clinical trial with a direct practical aim: to give children and families a sustainable way to manage diabetes day-to-day, reducing hospital admissions and severe hypoglycaemic episodes.
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The intervention is a competency-driven, motivational and patient-centred structured intensive psycho-educational programme specifically designed to improve diabetic control, self-management and quality of life in children and adolescents. CASCADE aims to establish effective delivery and cost effectiveness of a structured intensive education programme using psychological approaches that maximise engagement, motivation and long-term change. A developmentally appropriate curriculum will teach adaptation of insulin dosage, normal eating and management of day to day challenges (e.g. exercise, illness) enabling flexible self management in diverse diabetes regimens. Children and young people (8-16 years) will complete the programme with their families. The primary outcome will be glycosylated haemoglobin (HbA1c) levels 12 months after the intervention. Secondary out-comes will include a 24 month follow up measure of metabolic control in order to evaluate maintenance of the intervention effect, as well as hospital admissions, hypoglycaemic episodes, self-efficacy, diabetes specific quality of life measures, family functioning and measures of emotional and behavioural adjustment 12 and 24 months post intervention. Health economic modelling will establish the cost effectiveness of the intervention and its applicability to the wider NHS. The study will use a multicentre cluster randomised controlled trial with integral process and economic evaluation. The trial and reporting will follow MRC guidelines for clinical trials and CONSORT guidelines. A strong multidisciplinary study team combines the expertise of established clinical and research teams that have a published record in successfully developing clinical research interventions and completion of large scale randomised trials. Our extensive experience in teaching and training will be used to identify the time and resources required to train members of the study centres which will be incorporated into the economic modelling process. The project will use in-post NHS staff to deliver the intervention. Even a small reduction in HbA1c will have an impact on long term risk reduction with potential costs saving to the NHS.
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