title: Family-based psychoeducation and Care Ambassador intervention to improve glycemic control in youth with type 1 diabetes: a randomized trial.
abstract: OBJECTIVE
  Youth with type 1 diabetes frequently do not achieve glycemic targets. We aimed to improve glycemic control with a Care Ambassador (CA) and family-focused psychoeducational intervention.
  
  
  METHODS
  In a 2-yr, randomized, clinical trial, we compared three groups: (i) standard care, (ii) monthly outreach by a CA, and (iii) monthly outreach by a CA plus a quarterly clinic-based psychoeducational intervention. The psychoeducational intervention provided realistic expectations and problem-solving strategies related to family diabetes management. Data on diabetes management and A1c were collected, and participants completed surveys assessing parental involvement in management, diabetes-specific family conflict, and youth quality of life (QOL). The primary outcome was A1c at 2 yr; secondary outcomes included maintaining parent involvement and avoiding deterioration in glycemic control.
  
  
  RESULTS
  We studied 153 youth (56% female, median age 12.9 yr) with type 1 diabetes (mean A1c 8.4 ± 1.4%). There were no differences in A1c across treatment groups. Among youth with suboptimal baseline A1c ≥ 8%, more youth in the psychoeducation group maintained or improved their A1c and maintained or increased parent involvement than youth in the other two groups combined (77 vs. 52%, p = 0.03; 36 vs. 11%, p = 0.01, respectively) without negative impact on youth QOL or increased diabetes-specific family conflict.
  
  
  CONCLUSIONS
  No differences in A1c were detected among the three groups at 2 yr. The psychoeducational intervention was effective in maintaining or improving A1c and parent involvement in youth with suboptimal baseline glycemic control.
authors.affiliation: Genetics and Epidemiology Section, Joslin Diabetes Center, Boston, MA, 02215, USA.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Katz
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Volkening
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Butler
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Anderson
authors.forename: Lori M
authors.initials: LM
authors.lastname: Laffel
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism*; D017028:Caregivers / Q000523:psychology*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology / Q000628:therapy*; D005190:Family / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D010348:Patient Care Team; D010353:Patient Education as Topic / Q000379:methods*; D011613:Psychotherapy / Q000379:methods; D011788:Quality of Life; D011795:Surveys and Questionnaires; D000078329:Workforce
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: patient adherence; type 1 diabetes mellitus
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