Tonja R Nansel1, Dexter M Thomas2, Aiyi Liu2. 1. Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland. Electronic address: nanselt@mail.nih.gov. 2. Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
Abstract
INTRODUCTION:Youth with Type 1 diabetes and lower family income typically have poorer glycemic control. This post hoc analysis examines whether a family-oriented behavioral intervention for this population is differentially effective across income levels. METHODS:Families of youth aged 9-15 years with Type 1 diabetes (N=390; 49.2% female; age, 12.4 [1.7] years; hemoglobin A1c [HbA1c], 8.4 [1.2]; pump, 33.8%) at four U.S. pediatric endocrinology clinics participated in a 2-year RCT (data collected 2006-2011) of a clinic-integrated behavioral intervention designed to improve diabetes management by facilitating problem-solving skills, communication skills, and responsibility sharing. HbA1c was analyzed centrally. Family income was categorized as <$50,000 (low); $50,000 to <$100,000 (middle); and ≥$100,000 (high). Treatment effect was defined as the change in HbA1c from baseline to 2-year follow-up. A linear model tested the interaction of treatment effect with family income, controlling for race, insulin regimen, and site (analyzed in 2014). RESULTS: Baseline HbA1c was significantly poorer (p=0.004) in the low-income group. There was a significant overall effect of treatment group on change in HbA1c from baseline to follow-up (p=0.04). The interaction term for treatment by income group was not significant (p=0.44). Within each income category, a smaller deterioration in glycemic control was observed for the treatment group relative to controls. CONCLUSIONS: This clinic-integrated behavioral intervention was similarly effective in improving glycemic control among youth with Type 1 diabetes across income levels. This family-oriented problem-solving approach offers flexibility in addressing families' needs and may optimize impact on health outcomes across income groups. Published by Elsevier Inc.
RCT Entities:
INTRODUCTION: Youth with Type 1 diabetes and lower family income typically have poorer glycemic control. This post hoc analysis examines whether a family-oriented behavioral intervention for this population is differentially effective across income levels. METHODS: Families of youth aged 9-15 years with Type 1 diabetes (N=390; 49.2% female; age, 12.4 [1.7] years; hemoglobin A1c [HbA1c], 8.4 [1.2]; pump, 33.8%) at four U.S. pediatric endocrinology clinics participated in a 2-year RCT (data collected 2006-2011) of a clinic-integrated behavioral intervention designed to improve diabetes management by facilitating problem-solving skills, communication skills, and responsibility sharing. HbA1c was analyzed centrally. Family income was categorized as <$50,000 (low); $50,000 to <$100,000 (middle); and ≥$100,000 (high). Treatment effect was defined as the change in HbA1c from baseline to 2-year follow-up. A linear model tested the interaction of treatment effect with family income, controlling for race, insulin regimen, and site (analyzed in 2014). RESULTS: Baseline HbA1c was significantly poorer (p=0.004) in the low-income group. There was a significant overall effect of treatment group on change in HbA1c from baseline to follow-up (p=0.04). The interaction term for treatment by income group was not significant (p=0.44). Within each income category, a smaller deterioration in glycemic control was observed for the treatment group relative to controls. CONCLUSIONS: This clinic-integrated behavioral intervention was similarly effective in improving glycemic control among youth with Type 1 diabetes across income levels. This family-oriented problem-solving approach offers flexibility in addressing families' needs and may optimize impact on health outcomes across income groups. Published by Elsevier Inc.
Authors: Tim Wysocki; Michael A Harris; Lisa M Buckloh; Deborah Mertlich; Amanda Sobel Lochrie; Alexandra Taylor; Michelle Sadler; Nelly Mauras; Neil H White Journal: J Pediatr Psychol Date: 2006-01-09
Authors: Aaron M Secrest; Tina Costacou; Bruce Gutelius; Rachel G Miller; Thomas J Songer; Trevor J Orchard Journal: Ann Epidemiol Date: 2011-05 Impact factor: 3.797
Authors: Lori M B Laffel; Laura Vangsness; Alexa Connell; Ann Goebel-Fabbri; Deborah Butler; Barbara J Anderson Journal: J Pediatr Date: 2003-04 Impact factor: 4.406
Authors: P J Carter; W S Cutfield; P L Hofman; A J Gunn; D A Wilson; P W Reed; C Jefferies Journal: Diabetologia Date: 2008-08-05 Impact factor: 10.122
Authors: Tonja R Nansel; Ronald J Iannotti; Bruce G Simons-Morton; Leslie P Plotnick; Loretta M Clark; Linda Zeitzoff Journal: Diabetes Care Date: 2009-02-10 Impact factor: 19.112