Randomized trial of behavioral family systems therapy for diabetes: maintenance of effects on diabetes outcomes in adolescents.
OBJECTIVE
Studies showing that family communication and conflict resolution are critical to effective management of type 1 diabetes in adolescents have stimulated interest in evaluating psychological treatments targeting these processes. Previous trials have shown that Behavioral Family Systems Therapy (BFST) improved parent-adolescent relationships but not treatment adherence or glycemic control. This study evaluates a revised intervention, BFST for Diabetes (BFST-D), modified to achieve greater impact on diabetes-related family conflict, treatment adherence, and metabolic control.


METHODS
A sample of 104 families of adolescents with inadequate control of type 1 diabetes was randomized to either remain in standard care (SC) or to augmentation of that regimen by 12 sessions of either a multifamily educational support (ES) group or 12 sessions of BFST-D over 6 months. Pertinent measures were collected at baseline and at follow-up evaluations at 6, 12, and 18 months.


RESULTS
BFST-D was significantly superior to both SC and ES in effects on A1C, while effects on treatment adherence and family conflict were equivocal. Improvement in A1C appeared to be mediated by improvement in treatment adherence. A significantly higher percentage of BFST-D youth achieved moderate or greater improvement (>0.5 SD) in treatment adherence compared with the SC group at each follow-up and the ES group at 6 and 18 months. Change in treatment adherence correlated significantly with change in A1C at each follow-up.


CONCLUSIONS
These results support the efficacy of BFST-D in improving A1C, but further research is needed to identify the mechanisms of this effect and to achieve cost-effective dissemination of the intervention.
Wysocki
Tim
T
Nemours Childrens Clinic, Department of Biomedical Research, 807 Children's Way, Jacksonville, FL 32207, USA. twysocki@nemours.org
Harris
Michael A
MA
Buckloh
Lisa M
LM
Mertlich
Debbie
D
Lochrie
Amanda S
AS
Mauras
Nelly
N
White
Neil H
NH
D000293:Adolescent; D001521:Behavior Therapy; D003142:Communication; D003220:Conflict, Psychological; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy / Q000523:psychology*; D005006:Ethnicity; D005190:Family; D005196:Family Therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D018579:Patient Selection; D000297:Psychology, Adolescent; D011897:Random Allocation; D016896:Treatment Outcome
D006442:Glycated Hemoglobin