title: Multisystemic therapy for adolescents with poorly controlled type I diabetes: Stability of treatment effects in a randomized controlled trial.
abstract: 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.
authors.affiliation: Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA. dellis@med.wayne.edu
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Ellis
authors.forename: Thomas
authors.initials: T
authors.lastname: Templin
authors.forename: Sylvie
authors.initials: S
authors.lastname: Naar-King
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Frey
authors.forename: Phillippe B
authors.initials: PB
authors.lastname: Cunningham
authors.forename: Cheryl-Lynn
authors.initials: CL
authors.lastname: Podolski
authors.forename: Nedim
authors.initials: N
authors.lastname: Cakan
mesh_terms: 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
chemical_list: D006442:Glycated Hemoglobin