Primary Outcome Measures:
- Metabolic Control: Hemoglobin A1c (HbA1c) [ Time Frame: treatment termination, 6-month follow up ] [ Designated as safety issue: No ]
- Regimen Adherence: Diabetes Management Scale (DMS), Twenty-Four Hour Recall Interview, Glucose Meter Downloads [ Time Frame: treatment termination, 6-month follow up ] [ Designated as safety issue: No ]
- DKA admissions and emergency room (ER) Visits: hospital information systems data extraction, Service Utilization Questionnaire (SUQ) [ Time Frame: treatment termination, 6-month follow up ] [ Designated as safety issue: No ]
Secondary Outcome Measures:
- BMI percentile: Height and weight [ Time Frame: treatment termination, 6-month follow up ] [ Designated as safety issue: No ]
- Child Behavioral Adjustment: Child Behavior Checklist (CBCL) [ Time Frame: treatment termination, 6-month follow up ] [ Designated as safety issue: No ]
- Diabetes-Specific Family Functioning: Diabetes Family Responsibility Questionnaire (DFRQ), Parental Monitoring of Adolescent Diabetes Care (PMADC), Diabetes Social Support Questionnaire-Family (DSSQ-Family) [ Time Frame: treatment termination, 6-month follow up ] [ Designated as safety issue: No ]
- Parenting Skills: Alabama Parenting Questionnaire [ Time Frame: treatment termination, 6-month follow up ] [ Designated as safety issue: No ]
- Diabetes-Specific Social Support: Diabetes Social Support Questionnaire-Family (DSSQ-Family) [ Time Frame: treatment termination, 6-month follow up ] [ Designated as safety issue: No ]
- Peer Support for Diabetes Care: Diabetes Social Support Questionnaire for Friends (DSSQ-Friends) [ Time Frame: treatment termination, 6-month follow up ] [ Designated as safety issue: No ]
- Parent-Provider Interface: Measure of Process of Care (MPOC-20) [ Time Frame: treatment termination, 6-month follow up ] [ Designated as safety issue: No ]
The deterioration in regimen adherence and metabolic control associated with the adolescent developmental period is well-documented. However, a subset of high-risk adolescents with diabetes demonstrate much more serious adherence problems, as evidenced by chronically poor metabolic control (CPMC) and post-diagnostic admissions for diabetic ketoacidosis (DKA). Adolescents in CPMC represent a group at high risk for both short and long term diabetes complications and are therefore heavy users of medical resources and health care dollars. Minority and low-income children are over-represented among adolescents with CPMC.
The design for the proposed study is a randomized, controlled trial with a repeated measures design using a sample of 170 adolescents, 85 of whom will receive MST and 85 of whom will receive a telephone intervention to test the effect of increased attention (control condition). Subjects must have a current hemoglobin A1C (HbA1c) of >8% and an average HbA1c of >8% during the past year, must be diagnosed with insulin dependent diabetes for at least one year, be 10-17 years of age and reside in the metro Detroit tri-county area. Exclusion criteria are severe mental impairment/thought disorder, non-English speaking patient/parent or a co-morbid major medical condition such as cystic fibrosis. Families who are randomized to MST receive intensive, home-based family therapy for approximately six months. MST is a community based treatment originally designed for use with adolescents presenting with serious mental health problems, but which is adapted in the present study for use with chronically ill youth and serious adherence difficulties. Therapists meet with families two to three times per week at the beginning of treatment with a decreasing number of sessions at the end of treatment.
Purpose
