OPTIMIZING ADHERENCE AND GLYCEMIA IN YOUTH WITH NEW IDDM

Summary

Principal Investigator: L Laffel
Affiliation: Harvard University
Country: USA
Abstract: DESCRIPTION: The Diabetes Control and Complications Trial (DCCT) heightened awareness of the critical importance of near-normal glycemic levels for preventing the complications of insulin-dependent diabetes mellitus (IDDM). However, for youth with IDDM, difficulties with adhering to the complex treatment regimen often interferes with optimal control. In the investigators' current work, they have implemented an outpatient, office-based family intervention to promote adolescent adherence and optimal control through the process of increased parental involvement with diabetes management tasks. To date, they have demonstrated (1) a significant positive impact of the intervention on metabolic control in patients with short duration of diabetes (less than 4 years), (2) significantly less deterioration in parent involvement in insulin tasks in families receiving the intervention, and (3) that increasing parent-adolescent sharing in the tasks of diabetes management did not increase family conflict. The research plan proposed builds on this promising approach, as well as on two areas of relevant theory and research which also support intervening early in the disease course. First, crisis intervention theories define an initial period of heightened susceptibility to behavioral interventions following a crisis such as the diagnosis of IDDM. Second, longitudinal studies of youth newly diagnosed with IDDM have demonstrated that adherence deteriorates over the first 4 years of diabetes and then seems to "track", with children showing remarkable consistency in glycemic control as well as adherence over a decade of diabetes. The overall aim of this research is to study the impact of an outpatient Family Team Intervention on glycemic and adherence outcomes in 8-16 year olds during the first 4 years of IDDM. The proposed research will build on the investigators' current work and it is designed to assess whether the Team Intervention is superior to simple attention alone, or to routine medical care. This economical intervention may be generalized to a broad range of provider settings to help launch a new generation of patients with diabetes on a "track" of optimal metabolic control and healthy adherence behaviors. The proposed research will determine the effectiveness of the Team Intervention on medical and behavioral outcomes and is targeted to recently diagnosed youth during the early years following diagnosis before behavior patterns of patient and family become resistant to change.
Funding Period: 1993-08-01 - 2004-11-30
more information: NIH RePORT

Top Publications

  1. ncbi Depressive symptoms in children and adolescents with type 1 diabetes: association with diabetes-specific characteristics
    Korey K Hood
    Pediatric and Adolescent Section, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, USA
    Diabetes Care 29:1389-91. 2006
  2. ncbi Durability of insulin pump use in pediatric patients with type 1 diabetes
    Jamie R Wood
    Pediatric, Adolescent, and Young Adult Section, Genetics and Epidemiology Section, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215, USA
    Diabetes Care 29:2355-60. 2006
  3. ncbi Temporal trends in the treatment of pediatric type 1 diabetes and impact on acute outcomes
    Britta M Svoren
    Pediatric and Adolescent Section, Joslin Diabetes Center, Boston, Massachusetts 02215, USA
    J Pediatr 150:279-85. 2007
  4. ncbi Updated and revised Diabetes Family Conflict Scale
    Korey K Hood
    Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA
    Diabetes Care 30:1764-9. 2007
  5. ncbi The impact of modifiable family factors on glycemic control among youth with type 1 diabetes
    Deborah A Butler
    Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA
    Pediatr Diabetes 9:373-81. 2008
  6. ncbi Significant vitamin D deficiency in youth with type 1 diabetes mellitus
    Britta M Svoren
    Pediatric, Adolescent, and Young Adult Section, Genetics and Epidemiology Section, Joslin Diabetes Center, Boston, MA 02215, USA
    J Pediatr 154:132-4. 2009

Scientific Experts

  • Britta M Svoren
  • Deborah A Butler
  • Lori M B Laffel
  • Korey K Hood
  • Barbara J Anderson
  • Lisa K Volkening
  • Jamie R Wood
  • Jessica B Zuehlke
  • Alison Tovar
  • Debbie Butler
  • Lisa Volkening
  • Elaine C Moreland
  • Allison Maher
  • Samantha Huestis

Detail Information

Publications6

  1. ncbi Depressive symptoms in children and adolescents with type 1 diabetes: association with diabetes-specific characteristics
    Korey K Hood
    Pediatric and Adolescent Section, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, USA
    Diabetes Care 29:1389-91. 2006
  2. ncbi Durability of insulin pump use in pediatric patients with type 1 diabetes
    Jamie R Wood
    Pediatric, Adolescent, and Young Adult Section, Genetics and Epidemiology Section, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215, USA
    Diabetes Care 29:2355-60. 2006
    ..Patients discontinuing the pump were less adherent and did not achieve equivalent glycemic benefit compared with continued users; these patients require ongoing support aimed at improving adherence and outcomes...
  3. ncbi Temporal trends in the treatment of pediatric type 1 diabetes and impact on acute outcomes
    Britta M Svoren
    Pediatric and Adolescent Section, Joslin Diabetes Center, Boston, Massachusetts 02215, USA
    J Pediatr 150:279-85. 2007
    ..To evaluate temporal trends in pediatric type 1 diabetes (T1DM) management and resultant effects on outcomes...
  4. ncbi Updated and revised Diabetes Family Conflict Scale
    Korey K Hood
    Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA
    Diabetes Care 30:1764-9. 2007
    ..The purpose of this study was to update the Diabetes Family Conflict Scale (DFCS) in the era of intensive diabetes management and provide an indication of its psychometric properties...
  5. ncbi The impact of modifiable family factors on glycemic control among youth with type 1 diabetes
    Deborah A Butler
    Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA
    Pediatr Diabetes 9:373-81. 2008
    ..To identify modifiable family factors impacting glycemic control in youth with type 1 diabetes (T1DM) beyond the anticipated physical, developmental, and behavioral issues associated with adolescence...
  6. ncbi Significant vitamin D deficiency in youth with type 1 diabetes mellitus
    Britta M Svoren
    Pediatric, Adolescent, and Young Adult Section, Genetics and Epidemiology Section, Joslin Diabetes Center, Boston, MA 02215, USA
    J Pediatr 154:132-4. 2009
    ..Because individuals with type 1 diabetes mellitus possess multiple risk factors for skeletal fragility, ensuring vitamin D sufficiency throughout childhood and adolescence in this population seems especially warranted...