Journal
PEDIATRIC DIABETES
Volume 15, Issue 2, Pages 142-150Publisher
WILEY
DOI: 10.1111/pedi.12065
Keywords
type 1 diabetes mellitus; patient adherence
Categories
Funding
- Charles H. Hood Foundation
- Katherine Adler Astrove Youth Education Fund
- Maria Griffin Drury Pediatric Fund
- Eleanor Chesterman Beatson Fund
- NIH [T32 DK 7260-35]
- Health Resources and Services Administration [T32 HP10018, K12 DK094721-02, P30DK036836]
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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. Research design and 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.
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