Adherence to IDDM Regimen in Urban Youth

城市青年遵守 IDDM 方案

• 批准号: 7857952
• 负责人: DEBORAH A. ELLIS
• 金额: $ 40.82万
• 依托单位: WAYNE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-09-01 至 2012-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7857952
• 关键词: Accident and Emergency department; Adherence; Admission activity; Adolescent; Affect; Aftercare; Age; Attention; Attenuated; Award; Behavior; Behavioral; Blood Glucose; Body Weight decreased; Body mass index; Carbohydrates; Caring; Child; Childhood; Chronic; Chronic Disease; Clinical Trials; Complications of Diabetes Mellitus; Control Groups; Cost Measures; Deterioration; Development; Diabetes Mellitus; Diabetic Ketoacidosis; Diagnostic; Dose; Effectiveness; Effectiveness of Interventions; Enrollment; Ethnic Origin; Face; Family; Family psychotherapy; Gender; Glycosylated hemoglobin A; Goals; Grant; HIV Infections; Health; Healthcare; Home environment; Hospitals; Individual; Insulin; Insulin Resistance; Insulin-Dependent Diabetes Mellitus; Intervention; Investigation; Life; Low income; Measures; Mediator of activation protein; Medical; Medical Care Costs; Mental Health; Metabolic Control; Minority; Modeling; Obesity; Outcome; Outcome Study; Outpatient Health Services; Overweight; Parenting behavior; Parents; Participant; Patients; Physiological; Positioning Attribute; Principal Investigator; Process; Provider; Quality of life; Randomized Controlled Trials; Recommendation; Recording of previous events; Regimen; Research; Resources; Risk; Sampling; Single Parent; Single-Parent Family; Social support; Societies; Telephone; Testing; Therapeutic Intervention; Translating; Treatment Effectiveness; Visit; Vulnerable Populations; Weight; Work; Youth; aged; base; compare effectiveness; cost; design; experience; glycemic control; high risk; hospital utilization; improved; parental monitoring; programs; skills; treatment effect

DESCRIPTION (provided by applicant): The deterioration in regimen adherence and metabolic control associated with the adolescent developmental period is well known. However, a subset of high-risk adolescents with diabetes demonstrate much more serious adherence problems, as evidenced by chronically poor metabolic control (CPMC). Adolescents with CPMC represent a group at high risk for short and long-term diabetes complications and are therefore heavy users of both medical resources and health care dollars. Minorities are also over-represented among adolescents with CPMC. However, such adolescents are infrequent users of outpatient health services and traditional office-based approaches have been largely unsuccessful in improving adherence and metabolic control in this group. In addition, there are few clinical trials targeting high-risk adolescents. This competing renewal application represents the next step in our programmatic research to improve health outcomes for such at-risk, urban youth. Multisystemic Therapy (MST) is an intensive, home-based family therapy originally used with youths presenting with serious mental health problems and their families. Our group has now demonstrated the efficacy of MST for the improvement of regimen adherence and metabolic control and reduction of DKA admissions among adolescents with CPMC. However, our initial investigation identified two variables, number of parents in the home and adolescent overweight,that significantly affected study outcomes. The proposed investigation is a randomized controlled trial enrolling 170 participants that compares the effectiveness of an enhanced version of MST as compared to a telephone support (TS) intervention to treat CPMC in adolescents with insulin-managed diabetes. The MST- Enhanced (MST- ENHC) intervention includes two new modules: one for adherence to a weight loss program and one for building social support for single parents. Therefore, this new trial will allow us to test whether targeting adherence to weight loss recommendations in addition to adherence to more traditional aspects of the diabetes regimen will improve our ability to normalize HbA1c and whether targeting social support will improve the stability of improvements in adherence for single-parent families. If successful, MST will provide immediate assistance to a vulnerable population at high risk for diabetes complications and reduced quality of life.

描述（由申请人提供）：众所周知，与青少年发育期相关的治疗依从性和代谢控制的恶化。然而，一部分患有糖尿病的高危青少年表现出更严重的依从性问题，长期代谢控制不佳 (CPMC) 就证明了这一点。患有 CPMC 的青少年是短期和长期糖尿病并发症的高风险群体，因此是医疗资源和医疗保健资金的大量使用者。患有 CPMC 的青少年中少数族裔的比例也过高。然而，此类青少年很少使用门诊医疗服务，传统的基于办公室的方法在提高该群体的依从性和代谢控制方面基本上不成功。此外，针对高危青少年的临床试验也很少。这一竞争性更新应用程序代表了我们计划研究的下一步，旨在改善此类高危城市青年的健康状况。多系统治疗 (MST) 是一种强化的、以家庭为基础的家庭治疗，最初用于患有严重心理健康问题的青少年及其家人。我们的小组现已证明 MST 在改善 CPMC 青少年的治疗依从性和代谢控制以及减少 DKA 入院方面的功效。然而，我们的初步调查发现了两个显着影响研究结果的变量，即家中父母的数量和青少年超重。拟议的研究是一项随机对照试验，招募了 170 名参与者，比较了增强版 MST 与电话支持 (TS) 干预治疗胰岛素控制糖尿病青少年 CPMC 的有效性。 MST 增强型 (MST-ENHC) 干预措施包括两个新模块：一个用于坚持减肥计划，另一个用于为单亲父母建立社会支持。因此，这项新试验将使我们能够测试，除了坚持糖尿病治疗方案的更传统方面之外，以遵守减肥建议为目标是否会提高我们使 HbA1c 正常化的能力，以及以社会支持为目标是否会提高坚持改善的稳定性。单亲家庭。如果成功，MST 将立即向糖尿病并发症高风险和生活质量下降的弱势群体提供援助。

项目成果

The effects of weight status on treatment outcomes in a randomized clinical trial of multisystemic therapy for adolescents with type 1 diabetes and chronically poor metabolic control.

在一项对患有 1 型糖尿病且代谢控制长期不佳的青少年进行多系统治疗的随机临床试验中，体重状况对治疗结果的影响。

• DOI: 10.1111/j.1399-5448.2007.00273.x
• 发表时间: 2007
• 期刊: Pediatric diabetes
• 影响因子: 3.4
• 作者: Cakan,Nedim;Ellis,DeborahA;Templin,Thomas;Frey,Maureen;Naar-King,Sylvie
• 通讯作者: Naar-King,Sylvie

Multisystemic Therapy Improves the Patient-Provider Relationship in Families of Adolescents with Poorly Controlled Insulin Dependent Diabetes.

• DOI: 10.1007/s10880-015-9422-y
• 发表时间: 2015-09
• 期刊: Journal of clinical psychology in medical settings
• 影响因子: 2.2
• 作者: Carcone AI;Ellis DA;Chen X;Naar S;Cunningham PB;Moltz K
• 通讯作者: Moltz K

Linking caregiver strain to diabetes illness management and health outcomes in a sample of adolescents in chronically poor metabolic control.

• DOI: 10.1097/dbp.0b013e31824eaac8
• 发表时间: 2012-05
• 期刊: Journal of developmental and behavioral pediatrics : JDBP
• 作者: Carcone AI;Ellis DA;Naar-King S
• 通讯作者: Naar-King S

Social support for diabetes illness management: supporting adolescents and caregivers.

• DOI: 10.1097/dbp.0b013e31822c1a27
• 发表时间: 2011-10
• 期刊: Journal of developmental and behavioral pediatrics : JDBP
• 作者: Idalski Carcone A;Ellis DA;Weisz A;Naar-King S
• 通讯作者: Naar-King S

Multisystemic therapy for adolescents with poorly controlled type 1 diabetes: reduced diabetic ketoacidosis admissions and related costs over 24 months.

• DOI: 10.2337/dc07-2094
• 发表时间: 2008-09
• 期刊: Diabetes care
• 影响因子: 16.2
• 作者: Ellis D;Naar-King S;Templin T;Frey M;Cunningham P;Sheidow A;Cakan N;Idalski A
• 通讯作者: Idalski A