title: Randomized clinical trial of clinic-integrated, low-intensity treatment to prevent deterioration of disease care in adolescents with type 1 diabetes.
abstract: OBJECTIVE
  To evaluate the efficacy of two office-based treatments designed to prevent deterioration in glycemic control in young adolescents with type 1 diabetes in a randomized clinical trial. An individualized, more intensive family teamwork Coping skills program was compared with a diabetes Education treatment.
  
  
  METHODS
  A baseline assessment was followed by four brief treatment sessions and immediate posttesting over the course of 1.5 years. Families of 226 early adolescents (ages 11-14) were randomized to receive either individualized coping skills education or diabetes education as adjunctive treatment to quarterly medical appointments. Continued follow-up occurred at 3.5-month intervals for a long-term follow-up of up to 3 years. A post hoc Usual Care group facilitated comparisons of glycemic control.
  
  
  RESULTS
  Growth curve analysis showed that both treatment groups successfully prevented deterioration in adolescent disease care and simultaneously improved adolescent and parent quality of life that included indicators of more effective communication and reduced adherence barriers-without a concomitant increase in diabetes-related or general family conflict. However, contrary to expectation, the Education group was more efficacious than the Coping group in improvement of disease adherence and glycemic control over a 3-year follow-up.
  
  
  CONCLUSIONS
  Low-intensity office-based quarterly treatment can maintain or improve disease care adherence in early adolescence when provided to adolescent/parent dyads. Better outcomes are achieved when treatment goals and techniques match the needs of the targeted population.
authors.affiliation: Department of Psychology, Pediatrics and Psychiatry, Virginia Commonwealth University, Richmond, VACenter for New Designs in Leadership and Scholarship, Georgetown University, Washington, DC cholmes@richmond.edu.
authors.forename: Clarissa S
authors.initials: CS
authors.lastname: Holmes
authors.affiliation: Center for New Designs in Leadership and Scholarship, Georgetown University, Washington, DC.
authors.forename: Rusan
authors.initials: R
authors.lastname: Chen
authors.affiliation: Center for Translational Science, Children's National Health System, Washington, DC.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Mackey
authors.affiliation: Yale School of Nursing, Yale University, New Haven, CT.
authors.forename: Margaret
authors.initials: M
authors.lastname: Grey
authors.affiliation: Center for Translational Science, Children's National Health System, Washington, DC.
authors.forename: Randi
authors.initials: R
authors.lastname: Streisand
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000554:Ambulatory Care Facilities; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring; D002648:Child; D048909:Diabetes Complications / Q000517:prevention & control*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology* / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010290:Parents / Q000193:education; D010353:Patient Education as Topic; D000297:Psychology, Adolescent; D011788:Quality of Life
chemical_list: D001786:Blood Glucose