title: Impact of ambulatory, family-focused teamwork intervention on glycemic control in youth with type 1 diabetes.
abstract: OBJECTIVE
  To evaluate an ambulatory, family-focused intervention aimed at optimizing
  
  
  METHODS
  Study design We randomly assigned 105 children and adolescents, 8 to 17 years of age, with T1DM for < or =6 years, to a family-focused teamwork (TW) intervention or to standard multidisciplinary diabetes care (SC). Patients in both study groups were seen at 3- to 4-month intervals and were followed prospectively for 1 year. Measures of family involvement in diabetes tasks, DFC, and quality of life were performed at baseline and after 1 year. Hemoglobin A1c was measured at each visit.
  
  
  RESULTS
  Patients (n = 100) completed follow-up, (50 in TW and 50 in SC). At entry, A1c was 8.4% +/- 1.3% in TW and 8.3% +/- 1.0% in SC. After 1 year, A1c was 8.2% +/- 1.1% in TW compared with 8.7% +/- 1.5% in SC (P <.05). Both groups had similar frequencies of blood glucose monitoring (BGM) and insulin dosing. Families exposed to the TW intervention maintained or increased family involvement significantly more than families exposed to SC (P =.05). In multivariate analysis, the TW intervention and the daily frequency of BGM significantly predicted A1c (R (2) = 0.17, P =.05). Despite increased family involvement, the TW group reported no increase in DFC or decrease in quality of life.
  
  
  CONCLUSIONS
  The ambulatory TW intervention prevented the expected deterioration in glycemic control seen with SC in youths with T1DM of < or =6 years' duration. Successful family involvement may assist in the preservation of health and the prevention of long-term diabetes complications for youth with diabetes.
authors.affiliation: Pediatric and Adolescent Unit, the Behavioral Research and Mental Health Section, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215, USA. Lori.Laffel@joslin.harvard.edu
authors.forename: Lori M B
authors.initials: LM
authors.lastname: Laffel
authors.forename: Laura
authors.initials: L
authors.lastname: Vangsness
authors.forename: Alexa
authors.initials: A
authors.lastname: Connell
authors.forename: Ann
authors.initials: A
authors.lastname: Goebel-Fabbri
authors.forename: Deborah
authors.initials: D
authors.lastname: Butler
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000553:Ambulatory Care / Q000379:methods*; D002648:Child; D003220:Conflict, Psychological; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology / Q000628:therapy*; D022143:Family Nursing / Q000379:methods*; D005195:Family Relations; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010348:Patient Care Team; D010349:Patient Compliance / Q000523:psychology; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology