The CASCADE study

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


Thank you for visiting the CASCADE website.

Managing diabetes within a full and active life is challenging for children, young people and families. Learning to adapt to this condition and sharing increasing responsibility with their parents can be difficult to balance alongside additional peer pressure from friends who have more flexible lifestyles.

Specialist doctors, nurses, dieticians and psychologists all educate and support patients and parents during their clinic visits. An alternative approach is to bring together children and young people of similar ages, with their parents, to motivate them to adapt their insulin dosage, eat normally and manage other day-to-day challenges such as exercise and illness.

It is important to know whether this alternative approach is helpful for all young people with diabetes, and whether its results are sufficiently good for the NHS to recommend it. For instance, can it be delivered in busy clinics across the country, is it acceptable to patients and their families?

The NIHR Health Technology Assessment (HTA)programme provided 1.97m for a trial to evaluate these different approaches. Twenty-eight diabetes clinics across England and 362 children and young people, aged 8-16, and their families, took part in the randomised control trial, half trying the new approach and the other half continuing with standard care only. The trial aimed to be able to draw confident conclusions about the effects on control of diabetes (measured by HbA1c) and other outcomes including patient management of diabetes and use of health services, their health related quality of life, and psychosocial well-being. Patients, families and clinic staff were also asked their views about patient diabetes education and standard care. Economists assessed the costs of the new approach. The study started in July 2008 and finished on 31/12/12. The final report is due to published by the HTA in 2013.

The project was guided by a team with members having expertise about many different aspects of diabetes care and research. Team members came from: University College London; The Social Science Research Unit, Institute of Education, London: London School of Hygiene and Tropical Medicine, and Diabetes UK.


Contact Details; For any questions relating to the trial please contact Dr. Deborah Christie.

For technical issues with this site - please contact Mike Bennett. Site last updated 20th March 2013.