Behavioral Family Systems Therapy for Teens with Type 2 Diabetes: A Pilot

针对 2 型糖尿病青少年的行为家庭系统治疗：试点

• 批准号: 7982381
• 负责人: Lisa Marie Buckloh
• 金额: $ 19.13万
• 依托单位: NEMOURS CHILDREN'S CLINIC
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-01 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7982381
• 关键词: Adherence; Adolescent; Adult; Affect; Aftercare; Anxiety; Area; Attention; Behavior Therapy; Behavioral; Blood Pressure; Body Weight Changes; Body fat; Body mass index; Cardiovascular Diseases; Caring; Childhood; Clinic; Clinical Trials; Clinics and Hospitals; Communication; Communities; Data; Diabetes Mellitus; Diet; Discipline of Nursing; Eating Disorders; Educational Status; Effectiveness; Endocrinology; Exercise; Family; Focus Groups; Fostering; Future; Glycosylated hemoglobin A; Health; Health Care Costs; Health Policy; Incidence; Individual; Insulin-Dependent Diabetes Mellitus; Intake; Intervention; Intervention Trial; Interview; Learning; Life Style; Link; Lipids; Low Income Population; Maintenance; Manuals; Measures; Medical; Mental Depression; Mental Health; Metabolic Control; Minority; Neuropathy; Non-Insulin-Dependent Diabetes Mellitus; Nutritional; Obesity; Outcome; Parent-Child Relations; Parents; Participant; Patients; Physical activity; Pilot Projects; Population; Preparation; Primary Health Care; Problem Solving; Process; Psychological adjustment; Psychology; Public Health; Publishing; Quality of life; Randomized; Randomized Controlled Trials; Research; Research Design; Research Personnel; Retinal Diseases; Risk; Risk Factors; Robin bird; Sample Size; Science; Self Management; Site; Social Work; Societies; System; Teenagers; Testing; Time; Training; Translating; Treatment outcome; United States National Institutes of Health; Weight; Youth; base; behavior change; clinical practice; community setting; coping; design; diabetes management; diet and exercise; glycemic control; improved; medical complication; medical specialties; meetings; modifiable risk; multi-site trial; multidisciplinary; nutrition; pilot trial; psychologic; psychological outcomes; public health relevance; sedentary; self esteem; skills; staff intervention; standard care; success; successful intervention; symposium; treatment adherence; treatment effect; waist circumference

DESCRIPTION (provided by applicant): The incidence of type 2 diabetes mellitus (DM2) in youth is increasing dramatically with the rise in obesity in the U.S. and worldwide. DM2 in youth, as with adults, is clearly linked to modifiable risk factors such as obesity, sedentary lifestyle, and poor diet. Youth with DM2 are at increased risk for medical complications such as cardiovascular disease, retinopathy, and neuropathy, as well as psychological problems such as depression, anxiety, poor self-esteem, eating disorders, and poor coping and problem solving. Although there are studies demonstrating that family-based lifestyle and psychological interventions are successful in reducing obesity in youth and in improving metabolic control and adherence in youth with type 1 diabetes mellitus (DM1), very little has been published on potential lifestyle or psychological treatments for youth with DM2. Studies have shown that Behavioral Family Systems Therapy (BFST; Robin & Foster, 1989) has been effective in improving metabolic control, adherence, family communication, and problem solving in youth with DM1. This intervention could be effective in treating youth with DM2, as many of the skills necessary for good metabolic control, health outcomes, treatment adherence, and psychological adjustment are similar in both populations. This application proposes a randomized, controlled pilot trial of BFST-DM2, an individual psychological intervention tailored to meet the needs of teens with DM2. BFST will be adapted to make this intervention more feasible and relevant with minority and low-income populations and also to focus on weight management, exercise, and nutrition. The BFST-DM2 intervention includes 12 (90-minute) sessions over 6 months. Areas targeted for improvement will include metabolic control, weight/body mass index, treatment adherence, family lifestyle choices (activity, diet), family communication, and problem solving. One of the main aims of this pilot study is to gather exploratory information on the effectiveness of the BFST-DM2 intervention on measures of health outcomes, medical adherence, lifestyle changes, and family problem-solving and communication skills. In addition, it is an aim to estimate treatment effect size to determine the sample size needed to power a larger multi-site trial of the BFST-DM2 intervention. Other aims include determining factors associated with feasibility (recruitment, retention, participation, generalizability) as well as to modify the intervention to be culturally sensitive and to be more relevant to the individual needs of the DM2 adolescent population. The BFST-DM2 intervention will be compared with standard medical therapy on measures of health outcomes (metabolic control, body mass index, weight, waist circumference, body fat) physical activity (accelerometer), nutritional intake, treatment adherence, psychological adjustment (self-esteem, quality of life), family communication, and problem solving. The researchers will analyze predictors of treatment outcome and the treatment effects at the immediate post-treatment interval (6 months from baseline). Health outcomes and medical adherence data also will be collected 12 months from baseline to determine maintenance of treatment effects over time. PUBLIC HEALTH RELEVANCE: The results of this study could influence clinical practice of diabetes management for youth with DM2 by improving diabetes management, which could decrease short and long-term health complications. This pilot and the subsequent full-scale study also could have relevance to public health by reducing health care costs to individuals and society and by affecting health care policy for youth with DM2.

描述（由申请人提供）：随着美国和全球肥胖率的上升，青少年 2 型糖尿病 (DM2) 的发病率急剧增加。与成年人一样，青少年的 DM2 显然与肥胖、久坐的生活方式和不良饮食等可改变的危险因素有关。患有 DM2 的青少年出现心血管疾病、视网膜病变和神经病变等医疗并发症的风险增加，以及抑郁、焦虑、自尊心差、饮食失调以及应对和解决问题能力差等心理问题的风险增加。尽管有研究表明，以家庭为基础的生活方式和心理干预可成功减少青少年肥胖，并改善 1 型糖尿病 (DM1) 青少年的代谢控制和依从性，但关于潜在的生活方式或心理治疗的文章却很少。患有 DM2 的青少年。研究表明，行为家庭系统疗法（BFST；Robin & Foster，1989）可有效改善 1 型 DM 青少年的代谢控制、依从性、家庭沟通和问题解决。这种干预措施可以有效治疗患有 DM2 的青少年，因为良好的代谢控制、健康结果、治疗依从性和心理调整所需的许多技能在两个人群中都是相似的。该申请提出了一项 BFST-DM2 的随机对照试点试验，这是一种专为满足 DM2 青少年需求而定制的个体心理干预措施。 BFST 将进行调整，使这种干预措施更加可行，并与少数族裔和低收入人群相关，并重点关注体重管理、锻炼和营养。 BFST-DM2 干预包括 6 个月内的 12 次（90 分钟）疗程。改善的目标领域包括代谢控制、体重/体重指数、治疗依从性、家庭生活方式选择（活动、饮食）、家庭沟通和问题解决。这项试点研究的主要目的之一是收集关于 BFST-DM2 干预措施在健康结果、医疗依从性、生活方式改变以及家庭问题解决和沟通技巧方面的有效性的探索性信息。此外，其目的是估计治疗效果大小，以确定为 BFST-DM2 干预的更大规模多中心试验提供动力所需的样本量。其他目标包括确定与可行性相关的因素（招募、保留、参与、普遍性）以及修改干预措施，使其具有文化敏感性并更符合 DM2 青少年群体的个人需求。 BFST-DM2 干预措施将与标准药物治疗在健康结果（代谢控制、体重指数、体重、腰围、体脂）、身体活动（加速度计）、营养摄入、治疗依从性、心理调整（自我调整）方面进行比较。尊重、生活质量）、家庭沟通和问题解决。研究人员将分析治疗结果的预测因素以及治疗后立即间隔（距基线 6 个月）的治疗效果。还将从基线起收集 12 个月的健康结果和医疗依从性数据，以确定随着时间的推移治疗效果的维持情况。 公众健康相关性：这项研究的结果可以通过改善糖尿病管理来影响 DM2 青少年糖尿病管理的临床实践，从而减少短期和长期的健康并发症。这项试点和随后的全面研究还可以通过降低个人和社会的医疗保健成本以及影响 DM2 青少年的医疗保健政策来与公共卫生相关。