| 37
Pensar Enfermagem / v.27 n.01 / june 2023
DOI: 10.56732/pensarenf.v27i1.215
Review article
Interventions for self-management in adolescents
with Type 1 Diabetes: a scoping review protocol
Abstract
Introduction
Adolescent development involves building autonomy and progressive independence from
parental supervision. Challenges that are more complex when they have a diagnosis of type
1 diabetes and have to take responsibility for managing their condition. At this age, it is
crucial to implement interventions to promote self-management skills in adolescents with
type 1 diabetes.
Objective
The aim of this scoping review is to identify and map interventions that promote self-
management skills in adolescents with type 1 diabetes.
Methods
The methodology will follow the Joanna Briggs Institute recommendations for scoping
reviews. Studies published in English, Portuguese and Spanish between 2009-2021 will be
considered, with no geographical or cultural limitations. The process of data analysis,
extraction, and synthesis will be performed by two independent reviewers, based on the
inclusion criteria. The results of the study selection will be presented in a Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram for
scoping reviews. This protocol is registered at Open Science Framework
https://osf.io/z6wbj.
Results
Mapping the interventions for adolescents with type 1 diabetes, may constitute a tool for
the design of a structured intervention to promote self-management behaviour in
adolescents with type 1 diabetes and contribute to the dissemination of available evidence
on the topic.
Conclusion
The results from this review are expected to gather relevant information that will serve as a
basis for the development of a nursing intervention for adolescents with diabetes.
Keywords
Adolescent; Diabetes Mellitus, Type 1; Program Evaluation; Self-Management.
How to cite this article: Flora M, Malheiro I, Barros L, Coelho A N. Intervenções para a autogestão em
adolescentes com Diabetes Tipo 1: um protocolo de revisão scoping. Pensar Enf [Internet]. 2023 Jun;
27(1):37-44. Available from: https://doi.org/10.56732/pensarenf.v27i1.215
Marília Costa Flora1
orcid.org/0000-0002-9934-9143
Maria Isabel Dias Costa Malheiro2
orcid.org/0000-0002-9093-4821
Luísa Barros3
orcid.org/0000-0002-5075-0104
Adriana Neves Coelho4
orcid.org/0000-0002-6381-7128
1Master. Nursing School of Coimbra, Coimbra,
Portugal. Nursing Research, Innovation and
Development Centre of Lisbon (CIDNUR).
2PhD. Nursing School of Lisbon, Lisbon, Portugal.
Nursing Research, Innovation and Development
Centre of Lisbon (CIDNUR).
3PhD. Psychology Faculty, University of Lisbon,
Lisbon, Portugal.
4PhD. The Health Sciences Research Unit: Nursing
(UICISA:E), Nursing School of Coimbra (ESEnfC),
Coimbra, Portugal. Portugal Centre for Evidence-
Based Practice: A JBI Centre of Excellence, Coimbra,
Portugal.
Corresponding author
Marília Flora
E-mail: liaflora@gmail.com
Received: 23.11.2022
Accepted: 09.03.2023
38 | Flora, M.
Review article
Worldwide, more than 1.1 million children and adolescents
are living with diabetes, and the incidence of Type 1
Diabetes Mellitus (T1D) has been increasing, particularly at
ages below 15, with a higher prevalence in Europe than in
other regions.1
Adolescents are in a crucial phase for building their
autonomy, becoming progressively independent from their
parents and assuming more and more responsibility in
decision-making.2 During this phase, education and training
is essential for promoting T1D self-management.3 Once
there is no cure, treating T1D implies fostering healthy
growth to minimize the impact of this disease.3 The ultimate
goal for adolescents with T1D is to assume increased self-
care responsibility for managing diabetes.4
T1D is a chronic disease caused by an autoimmune reaction
in which the immune system destroys the pancreas beta
cells, preventing insulin production.5 The treatment of
diabetes is demanding and complex requiring continuous
control carried out through the management of the
following triad: diet, physical exercise, and tuning of insulin
doses.6 Regarding diet, counting carbohydrates is a complex
and challenging task (complex carbohydrates and simple
carbohydrates, e.g., glucose, fructose, lactose, sucrose, and
maltose). This task becomes even more complex with the
management of insulin and diet during physical
exercise/sports.6,7 Thus, managing T1D entails deep
thought on behaviors and decision-making, which is a
significant responsibility for adolescents and their families.8
Self-management focuses on self-regulation of chronic
disease and management of risk factors, and includes goal-
setting, self-monitoring, decision-making, self-care planning
and participation, self-assessment, and management of
physical, emotional, and cognitive responses associated with
behavior change.9 Promoting self-management is associated
with encouraging self-efficacy, knowledge, functionality,
and social interactions, improving mental health, providing
effective management of symptoms, a better quality of life,
and lowering the need for emergency services.10,11An
adequate self-management of the disease also drives better
health care and resource management12, preventing or
delaying secondary conditions such as micro and
macrovascular complications.13,14 Self-management of a
chronic condition is the individual ability to manage the
symptoms and treatment, physical repercussions,
psychosocial and emotional dimensions, and changes in the
lifestyle, which are inherent to chronic illness.15 Kate Lorig16
highlighted three self-management tasks (medical
management, role management and emotional
management) and several self-management skills (problem-
solving, decision-making, resource utilization, the formation
of a patient-provider partnership, action planning, and self-
tailoring).
To manage T1D is essential to have well-planned and
organized strategies and well-defined objectives.9
Management of diabetes involves knowledge about the
pathophysiologic of diabetes and acute and chronic
complications of the disease: hypo and hyperglycaemia,
insulin administration, measurement of blood glucose, and
health maintenance (diet, and physical exercise).17
Self-management support is the process of educating and
supporting people with a chronic condition, helping them
and their families understand their central role in managing
their disease.18 It includes a commitment to patient-centered
care. Implementing programs with specific strategies could
be helpful. Structured programs for T1D should integrate
topics within education, the definition of goals and
objectives, social inclusion, and self-efficiency associated
with glycaemic control measures.10 These programs
comprise psychoeducational principles, training of daily
routines, continuous support in promoting self-
management, parental engagement and participation, and
the use of new cognitive-behavioral techniques and new
technologies as motivators for adolescents is
recommended.11
It is up to the health teams within a multidisciplinary
network, particularly nurses, to facilitate and encourage the
self-management of diabetes in adolescents, therefore
contributing to a healthier and more capable population in
managing their disease.11 The team's intervention focuses on
the individual, their family, the group, and the community;
their intervention can occur in many contexts: work-based
during regular appointments, home-based, community-
based, school-based, or informal scenarios such as summer
camps.19
A preliminary search of MEDLINE (PubMed), CINAHL
(EBSCO), the Cochrane Database of Systematic Reviews
and JBI Evidence Synthesis, PROSPERO, and Open
Science Framework (OSF) was conducted, and no current
or underway systematic reviews or scoping reviews
(published or in progress) on the topic were identified.
More precisely, this scoping review seeks to answer the
following questions:
a) What are the characteristics of the interventions that
promote self-management in adolescents with Type 1
Diabetes?
b) Who are the professionals responsible for implementing
the interventions?
c) What are the indicators of change in self-management
skills after the intervention?
This scoping review aims to map interventions that promote
self-management skills in adolescents with type 1 diabetes.
Methods
This scoping review follows the Joanna Briggs Institute
(JBI) guidelines for scoping reviews.20,21 This review
protocol was registered in the Open Science Framework
(OSF) (https://osf.io/z6wbj /accessed on 11 November
2022).
Eligibility criteria
Participants
This scoping review will consider studies focused on
interventions to adolescents aged 10 to 19 years old with
T1D and/or their parents/family, that have participated in
an intervention focused on self-management of diabetes,
developed, or implemented by any health professionals.
Introduction
Pensar Enfermagem / v.27 n.01 / june 2023 | 39
DOI: 10.56732/pensarenf.v27i1.215
Review article
Concept
The concept considered in this review will include studies
that analyse programs and interventions to promote self-
management in adolescents with T1D: medical
management, role management, and emotional
management. Programs or interventions that do not show
results will be excluded.
Context
This scoping review will consider all interventions
implemented and evaluated to promote self-management
in adolescents carried out in any context. The context may
include interventions via virtual or attendance in a health
care setting (hospital or ambulatory), diabetic camps, or at
a person's home.
Types of Sources
This scoping review aims to identify and map any
interventions developed to promote self-management in
adolescents with T1D. For this purpose, the authors will
consider experimental and quasi-experimental study
designs, including randomized controlled trials, non-
randomized controlled trials, before and after studies.
Qualitative studies focusing on qualitative data will be
included, but are not limited to, designs such as
phenomenology, grounded theory, ethnography, qualitative
description, action research. In addition, systematic reviews
that meet the inclusion criteria will also be considered.
Search strategy
The search strategy will aim to locate both published and
unpublished studies. This review will use a three-step
search strategy. An initial limited search of MEDLINE (via
Pubmed) and CINAHL (via EBSCO) to identify articles on
the topic. We used the text words contained in the titles and
abstracts of relevant papers and the index terms "AND" or
"OR" to describe the articles were used to develop a
complete search strategy. The search strategy, including all
identified keywords and index terms, will be adapted for
each database and information source (Table
1). Afterwards, we will screen the reference list of all
included articles for additional studies. Studies published in
English, Portuguese and Spanish between 2009-2021 will
be considered.
The databases to be searched will include CINAHL Plus
with Full Text, PubMed, Cochrane Central Register of
Controlled Trials, LILACS, Scopus, Library, Information
Science & Technology Abstracts, PsycINFO, JBI Connect,
and the Cochrane Database of Systematic Reviews. Will
also include sources of unpublished studies and grey
literature from the RCAAP – Repositório Científico de
Acesso Aberto de Portugal.
Table 1 – Search Strategy conduced in March 2021
CINAHL complete Cochrane Central Register of Controlled Trials; Nursing & Allied Health Collection; Library, Information
Science & Technology Abstracts (via EBSCO)
S6
TI ( adolescen* OR teen* OR youth* OR young* ) AND TI ( diabetes OR "diabetes mellitus, type 1" OR T1DM
OR "diabetes mellitus type 1" OR "DM1" OR "type 1 diabetes" ) AND TI ( manage* OR "self management" OR
"self care" OR “self-efficacy” OR “health and life quality” OR " quality of life" OR "glycaemic control" OR “glycemic
control” OR Glycosylated hemoglobin* OR hemoglobin A* ) AND AB ( intervention* OR program* OR strateg*
OR project* OR action* OR function* OR care* OR preparation OR education OR instruction* OR train* ).
Filters: Boleano, English, Portuguese and Spanish, from 2009-2021
S5
TI ( adolescen* OR teen* OR youth* OR young* ) AND TI ( diabetes OR "diabetes mellitus, type 1" OR T1DM
OR "diabetes mellitus type 1" OR "DM1" OR "type 1 diabetes" ) AND TI ( manage* OR "self management" OR
"self care" OR “self-efficacy” OR “health and life quality” OR " quality of life" OR "glycaemic control" OR “glycemic
control” OR Glycosylated hemoglobin* OR hemoglobin A* ) AND AB ( intervention* OR program* OR strateg*
OR project* OR action* OR function* OR care* OR preparation OR education OR instruction* OR train* ).
Filters: Boleano, from 2009-2021
S4
TI ( adolescen* OR teen* OR youth* OR young* ) AND TI (diabetes OR "diabetes mellitus, type 1" OR T1DM OR
"diabetes mellitus type 1" OR "DM1" OR "type 1 diabetes" ) AND TI ( manage* OR "self management" OR "self
care" OR “self-efficacy” OR “health and life quality” OR " quality of life" OR "glycaemic control" OR “glycemic
control” OR Glycosylated hemoglobin* OR hemoglobin A* ) AND AB ( intervention* OR program* OR strateg*
OR project* OR action* OR function* OR care* OR preparation OR education OR instruction* OR train* )
S3
TI (adolescen* OR teen* OR youth* OR young*) AND TI (diabetes OR "diabetes mellitus, type 1" OR T1DM OR
"diabetes mellitus type 1" OR "DM1" OR "type 1 diabetes") AND TI (manage* OR "self management" OR "self
care" OR “self-efficacy” OR “health and life quality” OR " quality of life" OR "glycaemic control" OR “glycemic
control” OR Glycosylated hemoglobin* OR hemoglobin A*)
S2
TI (adolescen* OR teen* OR youth* OR young*) AND TI (diabetes OR "diabetes mellitus, type 1" OR T1DM OR
"diabetes mellitus type 1" OR "DM1" OR "type 1 diabetes")
S1
TI adolescen* OR teen* OR youth* OR young*
Pubmed
adolescent [MeSH Terms] AND diabetes mellitus, type 1 [MeSH Terms] AND ("self-management" [MeSH Terms]
OR self-care [MeSH Terms] OR quality of life [MeSH Terms] OR "glycated hemoglobin a" [MeSH Terms]) AND
(Program Evaluation [MeSH Terms] OR "health promotion" [MeSH Terms]).
Filters: English, from 2009-2021
Medline complete (via EBSCO)
adolescent [MeSH Terms] AND diabetes mellitus, type 1 [MeSH Terms] AND ("self-management" [MeSH Terms]
OR self-care [MeSH Terms] OR quality of life [MeSH Terms] OR "glycated hemoglobin a" [MeSH Terms]) AND
(Program Evaluation [MeSH Terms] OR "health promotion" [MeSH Terms]).
Filters: English, from 2009-2021
40 | Flora, M.
Review article
Study/Source of Evidence selection
Following the search, all identified records will be removed
as duplicates using the Mendeley. Two independent
reviewers will be screening titles and abstracts for
assessment against the inclusion criteria for the review.
Potentially relevant studies will be retrieved in total. Two
independent reviewers will assess the full-text citations
against the inclusion criteria. The scoping review will report,
in the full text, the reasons for the exclusion of sources of
evidence in full text that do not meet the inclusion criteria.
Any disagreements between the reviewers will be discussed
with a third reviewer. The search results and the study
inclusion process will be reported in full in the final scoping
review and presented in a Preferred Reporting Items for
Systematic Reviews and Meta-analyses extension for
scoping review (PRISMA-ScR) flow diagram.20
Data Extraction
Quantitative and qualitative data will be extracted from
articles included in the review by two independent reviewers
using a data extraction tool developed by the reviewers as
indicated by the methodology for scoping reviews proposed
by JBI.22The data extracted will include specific details about
the participants, concept, context, study methods, and
critical findings relevant to the review questions. A draft
extraction form is provided (Table 2). The draft data
extraction tool will be modified and revised as necessary
while extracting data from each included evidence source.
We will detail all modifications in the scoping review. Will
resolve any disagreements between the reviewers through
discussion or with an additional reviewer/s. If appropriate,
we will contact the authors of papers to request missing or
additional data, where required.
Table 2 - Data Extraction Instrument
Main Field
Extraction Categories
Category Description
Study ID
Reference number; Authors; Year; Title; Journal; Issue no; Vol
no.
Type of reference
1. Primary research
2. Systematic review
Inclusion/
Exclusion criteria
P – Adolescents with T1D
C - Programs and/or interventions to promote self-management
in adolescents with T1D. Excludes programs do not should
results.
C - Interventions via virtual or attendance in health care setting
(hospital or ambulatory), diabetic camps or at person’s home.
1. Yes
2. No
Characteristics of
population
Who are the participants involved in the intervention?
Who are the healthcare professionals in the healthcare
practice/intervention?
1. Adolescents
2. Adolescents and parents/
family
1. Physicians
2. Nurses
3. Psychologists
4. Physiotherapists
5. Nutritionists
6. Multidisciplinary
7. Other, please specify
Characteristics of
interventions
How is the intervention designed?
General characteristics of interventions
1. Educational
2. Psychosocial
3. Supportive
4. Communicational
5. Other, please specify
1. Contents
2. In group
3. Individually
4. Duration of the sessions
Characteristics of
context
What is the setting of intervention delivery?
6. Health care setting
(Hospital or ambulatory)
7. Person’s home
8. Virtual
9. Other, please specify
Outcomes
What are the indicators of change in self-management skills after
the intervention?
1. Self-management
(Acute and chronic
complications of the disease:
Pensar Enfermagem / v.27 n.01 / june 2023 | 41
DOI: 10.56732/pensarenf.v27i1.215
Review article
hypo and hyperglycemia, insulin
administration, measurement of
blood glucose, health
maintenance: diet, and physical
exercise)
2. Self-efficacy
3. Knowledge
4. Quality of life
5. Self-care
6. Glycated Hemoglobin
Results
Data analysis and presentation
The results will be summarized and presented in a tabular
form. A draft results table has been developed to address
each question (table 3). A narrative summary accompanies
the tabular results and describes how these are related to the
review's objective and questions. We will present what is
known, the literature gaps in the field, and the potential
implications for health care and research.
Table 3 - Tabular Summary for Results Presentation
Review questions
Study 1
Study 2
Study 3
...
a) What are the characteristics of the interventions that promote self-management
in adolescents with T1D?
b) Who are the professionals responsible for implementing the interventions?
c) What are the indicators of change in self-management skills after the
intervention?
Discussion
Mapping of the available interventions implemented for
adolescents with T1D may constitute a tool to design of a
structured intervention to promote self-management
behaviour in adolescents with T1D and contribute to the
dissemination of available evidence on the topic. This
scoping review will only consider English, Portuguese, and
Spanish studies, which can be registered as potential study
limitation. In order to minimize the effects of this limitation,
if we find an article relevant to the topic, in another
language, we undertake to use tools so that can be integrated
in this review.
Conclusions
The literature points to the development of interventions in
different contexts for adolescents with T1D focused on self-
management and empowerment to promote autonomy to
promote better quality of life and reduce complications. The
scoping review, which will result from this protocol is
expected to gather relevant information that will serve as a
basis for the development of a nursing intervention for
adolescents with T1D.
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