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 (CASCADE).

This is a highly clinically meaningful effect, given that the Diabetes Control and Complications Trial showed conclusively that a reduction of approximately 1.5% in HbA1c reduced the risk of microvascular complications in adults by 40% (microalbuminuria) to 75% (retinopathy) over 6.5 years,.[ 3 ] with similar benefits seen in adolescents.[ 28 ] There is considerable other evidence that smaller reductions in HbA1c, of the order of 0.5% are clinically highly significant, e.g. the DCCT found a continuous association of higher HbA1c and greater microvascular risk.[ 3 ] The DAFNE trial in adults had an effect size of approximately 1% reduction in HbA1c.[ 11 ] Additionally, a reduction of 0.5 SD is half the effect size identified in our pilot work (1.0 SD).

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