Program Evaluation of Camp Kudzu: Impact of Camp Attendance on HgA1C Levels in Adolescents

Purpose: Type 1 Diabetes Mellitus (T1DM) treatment regimens are complex and difficult to manage especially in adolescents where non-adherence is higher than any other age group due to desires for peer acceptance, reactions to overprotective parents, adolescents’ denial of disease and complications, as well as anxiety and depression. Sub-optimal habits formed in adolescents are difficult to overcome in adulthood. Thirty -thousand children attend diabetes camps in the United States each year, and it is well documented these camps are the ideal setting for continued diabetes education.  While the literature demonstrates diabetes camps are effective at increasing knowledge, the evidence is weaker at showing improvement in self-management behaviors and related decrease in HgA1C (A1C) levels.  The purpose of this study is to evaluate the impact of camp attendance on T1DM self-management as evidenced by decreased A1C levels in adolescents that attended a camp for children with diabetes.

Methods: A retrospective medical record review was conducted comparing campers (n=221) and a matched sample of non-campers (n=203).  Demographic data and pre/post camp A1C levels were collected from each medical record.  Campers attended the diabetes camp in 2013 and non-campers were matched by gender, age and pediatric endocrinology practice; A1C levels for non-campers were collected using the equivalent time periods of their matched campers. A1C levels were evaluated by means of the 2-sample t-test, paired t-test and chi square test.

Results: The majority of the participants were female and fell within the range of 11-14 years age range (campers, 69%; non-campers, 67%). Camp attendance did not significantly impact the A1C levels. There was no significant improvement noted in campers’ mean 12-month pre and post-camp A1C levels (8.29, 8.34 respectively, p=0.462).  The pre-camp comparison of campers’ and non-campers’ mean A1C level was 8.29 and 8.55 respectively (p=0.084). The A1C levels collected 2-4 months post camp for campers and non-campers was 8.30 and 8.27, respectively (p=0.887). The mean 12-month post camp A1C level for campers and non-campers was 8.34 and 8.59, respectively (p=0.112). A review of demographics and associated impact of camp attendance indicated a decrease in A1C values in campers attending camp 8-10 years (campers mean A1C levels pre-camp 8.93 and post-camp 8.59) and length of diagnosis >10 years (pre-camp mean A1C levels: campers 8.72, non-campers 9.95, p=0.05; post camp mean A1C levels, campers 8.4, non-campers 10.06, p=0.014). 

Conclusion:

While camp attendance did not have a significant impact on self-management behavior reflected in an improvement of A1C levels, there could be a clinical effect with a decrease in A1C levels in some situations. A majority of the sample was in the 11-14 year age range, thus puberty could have affected the results since the hormonal influences of puberty on insulin resistance has a direct negative impact on glycemic control.  Further studies need to be done focusing on older adolescents and young adults that had previously attended diabetes camp.  Even though this study did not indicate that camp attendance had a significant impact on A1C levels in adolescents, camp attendance is still worthwhile.  Summer camps are documented as the ideal setting for continued diabetes education and increasing knowledge of self-management.  They also create an environment for adolescents living with T1DM to meet new friends that share a common bond of their diagnosis, be surrounded with role models, and gain a support system.