title: An office-based intervention to maintain parent-adolescent teamwork in diabetes management. Impact on parent involvement, family conflict, and subsequent glycemic control.
abstract: OBJECTIVE
  To design and evaluate an office-based intervention aimed at maintaining parent-adolescent teamwork in diabetes management tasks without increasing diabetes-related family conflict.
  
  
  METHODS
  There were 85 patients (aged 10-15 years, mean 12.6 years) with type 1 diabetes (mean duration 5.5 years; mean HbA1c 8.5%) who were randomly assigned to one of three study groups--teamwork, attention control, and standard care--and followed for 24 months. At each visit, parent involvement in insulin administration and blood glucose monitoring was assessed. The teamwork and attention control interventions were integrated into routine ambulatory visits over the first 12 months (four medical visits). Measures of diabetes-related family conflict were collected at baseline and after 12 months. All patients were followed for an additional 12 months with respect to glycemic control.
  
  
  RESULTS
  In the teamwork group, there was no major deterioration (0%) in parent involvement in insulin administration, in contrast to 16% major deterioration in the combined comparison (attention control and standard care) group (P < 0.03). Similarly, no teamwork families showed major deterioration in parent involvement with blood glucose monitoring versus 11% in the comparison group (P < 0.07). On both the Diabetes Family Conflict Scale and the Diabetes Family Behavior Checklist, teamwork families reported significantly less conflict at 12 months. An analysis of HbA1c over the 12- to 24-month follow-up period indicated that more adolescents in the teamwork group (68%) than in the comparison group (47%) improved their HbA1c (P < 0.07).
  
  
  CONCLUSIONS
  The data demonstrate that parent involvement in diabetes management tasks can be strengthened through a low-intensity intervention integrated into routine follow-up diabetes care. Moreover, despite increased engagement between teen and parent centered around diabetes tasks, the teamwork families showed decreased diabetes-related family conflict. Within the context of a broader cultural recognition of the protective function of parent involvement in the lives of adolescents, the findings of this study reinforce the potential value of a parent-adolescent partnership in managing chronic disease.
authors.affiliation: Joslin Diabetes Center, Boston, Massachusetts 02215, USA. banderso@joslin.harvard.edu
authors.forename: B J
authors.initials: BJ
authors.lastname: Anderson
authors.forename: J
authors.initials: J
authors.lastname: Brackett
authors.forename: J
authors.initials: J
authors.lastname: Ho
authors.forename: L M
authors.initials: LM
authors.lastname: Laffel
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring; D002648:Child; D003220:Conflict, Psychological; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology* / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009819:Office Visits; D010287:Parent-Child Relations; D010290:Parents / Q000193:education*; D010353:Patient Education as Topic; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose