| Abstrakt: |
Does multysystemic therapy increase adherence to blood glucose testing and isulin use, improve metabolic control, and reduce hospital use in adolescents with type 1 diabetes and chronically poor metabolic control?METHODS:Design: randomised controlled trial.Allocation: {concealed}.*Blinding: blinded (assessor of reason for hospital visit, {data collectors, and data analysts}*).Follow up period: 7 months.Setting: a diabetes clinic in a tertiary care children's hospital in Detroit, Michigan, USA.Patients: 127 English speaking adolescents who were 10-17 years of age (mean age 13 y, 51% girls, 63% African-American) and had type 1 diabetes for >/= 1 year (mean 5 y), an average HbA[1c], concentration >/=8% in the previous year, and a most recent HbA[1c] concentration >/=8%. Adolescents with moderate to severe mental retardation or psychosis were excluded.Intervention: 64 adolescents were allocated to multisystemic therapy plus standard medical care (quarterly medical visits to a diabetes clinic, with care from a multidisciplinary team). Multisystemic therapy consisted of intensive, family centred, community based treatment originally designed for adolescents with serious antisocial behaviour. A trained therapist tailored treatment goals and interventions to adherence problems within the family system, peer network, and community systems. Intervention techniques were selected from an evidence-based menu that included cognitive behaviour therapy, parent training, and behavioural family systems therapy. The therapist met with the family 2-3 times per week until treatment goals were met (approximately 6 mo). 63 adolescents were allocated to standard medical care alone. Randomisation was stratified by baseline HbA[1c] concentration.Outcomes: change from baseline in HbA[1c], concentration; frequency of blood glucose testing (based on average daily blood glucose meter use from the previous 14 d and 24 Hour Recall Interview); insulin and dietary adherence (24 Hour Recall Interview); and diabetes related emergency department visits and hospital admissions in the previous 6 months (from hospital records).Patient follow up: 87% of patients completed the follow up assessment; all patients were included in the intention to treat analysis, assuming no change from baseline for those without follow up.MAIN RESULTSAt 7 months, the multisystemic therapy group had more improvement than the standard care group in frequency of blood glucose monitoring based on the 24 Hour Recall Interview (p = 0.01 for group x time interaction) and blood glucose meter readings (p=.001); and a greater reduction in hospital admissions (p =0.01). The groups did not differ for changes in HbA[1c] concentrations (p = 0.09), insulin adherence (p=0.17), dietary adherence (p=0.85), or emergency department visits (p = 0.10).CONCLUSIONMultisystemic therapy plus standard care improved adherence to blood glucose testing and reduced hospital admissions more than standard care alone in adolescents with type 1 diabetes and chronically poor metabolic control; it did not improve metabolic control. * Information provided by author. [ABSTRACT FROM AUTHOR] |
