Randomized trial of behavioral family systems therapy for diabetes: maintenance of effects on diabetes outcomes in adolescents.

Full Abstract

OBJECTIVE:
Studies showing that family communication and conflict resolution are critical to effective management of type 1 diabetes in adolescents have stimulated interest in evaluating psychological treatments targeting these processes. Previous trials have shown that Behavioral Family Systems Therapy (BFST) improved parent-adolescent relationships but not treatment adherence or glycemic control. This study evaluates a revised intervention, BFST for Diabetes (BFST-D), modified to achieve greater impact on diabetes-related family conflict, treatment adherence, and metabolic control.

RESEARCH DESIGN AND METHODS:
A sample of 104 families of adolescents with inadequate control of type 1 diabetes was randomized to either remain in standard care (SC) or to augmentation of that regimen by 12 sessions of either a multifamily educational support (ES) group or 12 sessions of BFST-D over 6 months. Pertinent measures were collected at baseline and at follow-up evaluations at 6, 12, and 18 months.

RESULTS:
BFST-D was significantly superior to both SC and ES in effects on A1C, while effects on treatment adherence and family conflict were equivocal. Improvement in A1C appeared to be mediated by improvement in treatment adherence. A significantly higher percentage of BFST-D youth achieved moderate or greater improvement (>0.5 SD) in treatment adherence compared with the SC group at each follow-up and the ES group at 6 and 18 months. Change in treatment adherence correlated significantly with change in A1C at each follow-up.

CONCLUSIONS:
These results support the efficacy of BFST-D in improving A1C, but further research is needed to identify the mechanisms of this effect and to achieve cost-effective dissemination of the intervention.

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Author information

Author/s: Wysocki, Tim (T); Harris, Michael A (MA); Buckloh, Lisa M (LM); Mertlich, Debbie (D); Lochrie, Amanda S (AS); Mauras, Nelly (N); White, Neil H (NH);

Affiliation: Nemours Childrens Clinic, Department of Biomedical Research, 807 Children's Way, Jacksonville, FL 32207, USA. twysocki(-atsign-)nemours.org

Grants: K24-DK67128 (Agency:NIDDK NIH HHS) ; M0I-RR00036 (Agency:NCRR NIH HHS) ; P60-DK20579 (Agency:NIDDK NIH HHS) ; R01-DK43802 (Agency:NIDDK NIH HHS)

Journal and publication information

Publication Type: Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural

Journal: Diabetes care (Diabetes Care), published in United States. (Language: eng)

Reference: 2007-Mar; vol 30 (issue 3) : pp 555-60

Dates: Created 2007/02/28; Completed 2007/04/27; Revised 2007/12/03;

PMID: 17327320, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adolescent
Adolescent Psychology
Behavior Therapy
Communication
Conflict (Psychology)
Diabetes Mellitus, Type 1 - blood; drug therapy; psychology
Ethnic Groups
Family

Family Therapy
Female
Hemoglobin A, Glycosylated - analysis
Humans
Male
Patient Selection
Random Allocation
Treatment Outcome

Associated Chemicals: Hemoglobin A, Glycosylated (0)

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