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.
RCT Entities:
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.
Authors: Margaret Grey; Robin Whittemore; Sarah Jaser; Jodie Ambrosino; Evie Lindemann; Lauren Liberti; Veronika Northrup; James Dziura Journal: Res Nurs Health Date: 2009-08 Impact factor: 2.228
Authors: Tim Wysocki; Tonja R Nansel; Grayson N Holmbeck; Rusan Chen; Lori Laffel; Barbara J Anderson; Jill Weissberg-Benchell Journal: J Pediatr Psychol Date: 2008-12-26
Authors: Michelle L Katz; Craig R Kollman; Carly E Dougher; Mohamed Mubasher; Lori M B Laffel Journal: Diabetes Care Date: 2016-10-20 Impact factor: 19.112