Multisystemic therapy for adolescents with poorly controlled type I diabetes: Stability of treatment effects in a randomized controlled trial.
The primary purpose of the present study was to determine whether multisystemic therapy (MST), an intensive, home-based psychotherapy, improved regimen adherence, metabolic control, and rates of hospitalization for diabetic ketoacidosis (DKA) among adolescents with chronically poorly controlled Type 1 diabetes 6 months after the completion of treatment. A randomized controlled trial was conducted with 127 adolescents and their families. Mean participant age was 13.2 years. Sixty-three percent of participants were African American, and 51% were female. Data were collected at baseline, treatment termination, and 6-month follow-up. Changes in glycated hemoglobin (HbA1c), frequency of blood glucose testing (BGT), and rate of DKA admissions were assessed. In intent-to-treat analyses, a main effect of MST on DKA admissions was found at both treatment termination and follow-up. Improvements in BGT were moderated by family composition; only 2-parent MST families maintained improvements at follow-up. Improvements in HbA1c for the MST group at treatment termination were lost at follow-up. Results show that intensive, home-based psychotherapy created stable reductions in serious lapses in adherence, as indexed by episodes of DKA, among youth with poorly controlled diabetes.
Ellis
Deborah A
DA
Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA. dellis@med.wayne.edu
Templin
Thomas
T
Naar-King
Sylvie
S
Frey
Maureen A
MA
Cunningham
Phillippe B
PB
Podolski
Cheryl-Lynn
CL
Cakan
Nedim
N
D000293:Adolescent; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology / Q000534:rehabilitation*; D005260:Female; D006442:Glycated Hemoglobin; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011613:Psychotherapy / Q000379:methods*; D017211:Treatment Failure
D006442:Glycated Hemoglobin