Use of Multisystemic Therapy to Improve Regimen Adherence Among Adolescents With Type 1 Diabetes in Chronic Poor Metabolic Control: A randomized controlled trial

• Published in: Diabetes care Vol. 28; no. 7; pp. 1604 - 1610
• Main Authors: Ellis, Deborah A, Frey, Maureen A, Naar-King, Sylvie, Templin, Thomas, Cunningham, Phillippe, Cakan, Nedim
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.07.2005
• Subjects: administration & dosage; Adolescent; adolescents; Adult; Biological and medical sciences; blood glucose; Blood Glucose - metabolism; Blood Glucose Self-Monitoring; Case studies; children; Clinical outcomes; Diabetes; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 1 - drug therapy; Diabetes. Impaired glucose tolerance; Drug Administration Schedule; Drug therapy; Emergencies; Emergencies - epidemiology; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; epidemiology; Ethnic Groups; Ethnicity; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Glycated Hemoglobin; Glycated Hemoglobin A - metabolism; Humans; Hypoglycemic Agents; Hypoglycemic Agents - therapeutic use; Insulin; Insulin - administration & dosage; Insulin - therapeutic use; Insulin Infusion Systems; insulin-dependent diabetes mellitus; interviews; Male; Medical sciences; Metabolism; Parent-Child Relations; Patient Compliance; Patient Dropouts; Psychotherapy; randomized clinical trials; Teenagers; therapeutic use; Type 1 diabetes; Endocrinopathy; Human; Immunopathology; Psychotherapy; Autoimmune disease; Hospitalization; Adhesion; Treatment; Surveillance; Type 1 diabetes; Adolescent; Randomised controlled trial; Therapeutic protocol; Glycemia
• ISSN: 0149-5992
• DOI: 10.2337/diacare.28.7.1604

OBJECTIVE:--The aim of this study was to determine whether multisystemic therapy (MST), an intensive, home-based psychotherapy, could improve adherence and metabolic control and decrease rates of hospital utilization among adolescents with chronically poorly controlled type 1 diabetes. RESEARCH DESIGN AND METHODS--A randomized controlled trial was conducted with 127 adolescents with type 1 diabetes and chronically poor metabolic control (HbA[subscript 1c] [A1C] [>/=]8% for the past year) who received their diabetes care in a children's hospital located in a major Midwestern city. Participants randomly assigned to MST received treatment for [approximately]6 months. Data were collected at baseline and at 7 months posttest (i.e., treatment termination). Changes in A1C adherence, as measured by semistructured interviews and blood glucose meters and hospital admissions and emergency department visits, were assessed. RESULTS:--In intent-to-treat analyses, participation in MST was associated with significant improvements in the frequency of blood glucose testing as assessed by blood glucose meter readings (F[1,125] = 16.75, P = 0.001) and 24-h recall interviews (F[1,125] = 6.70, P = 0.011). Participants in MST also had a decreasing number of inpatient admissions, whereas the number of inpatient admissions increased for control subjects (F[1,125] = 6.25, P = 0.014). Per protocol analyses replicated intent-to-treat analyses but also showed a significant improvement in metabolic control for adolescents receiving MST compared with control subjects (F[1,114] = 4.03, P = 0.047). CONCLUSIONS:--Intensive, home-based psychotherapy improves the frequency of blood glucose testing and metabolic control and decreases inpatient admissions among adolescents with chronically poorly controlled type 1 diabetes.