OBJECTIVE -The study aim was to determine if multisystemic therapy (MST), an intensive home-based psychotherapy, could reduce hospital admissions for diabetic ketoacidosis (DKA) in youth with poorly controlled type 1 diabetes over 24 months. Potential cost savings from reductions in admissions were also evaluated. RESEARCH DESIGN AND METHODS-A total of 127 youth were randomly assigned to MST or control groups and also received standard medical care.RESULTS -Youth who received MST had significantly fewer hospital admissions than control subjects ( 2 ϭ 11.77, 4 d.f., n ϭ 127; P ϭ 0.019). MST-treated youth had significantly fewer admissions versus their baseline rate at 6-month (P ϭ 0.004), 12-month (P ϭ 0.021), 18-month (P ϭ 0.046), and 24-month follow-up (P ϭ 0.034). Cost to provide MST was 6,934 USD per youth; however, substantial cost offsets occurred from reductions in DKA admissions.CONCLUSIONS -The study demonstrates the value of intensive behavioral interventions for high-risk youth with diabetes for reducing one of the most serious consequences of medication noncompliance. Diabetes Care 31:1746-1747, 2008W e have previously reported on multisystemic therapy (MST), an intensive home-based family therapy, for youth with chronically poor metabolic control (CPMC). MST produced improvements in metabolic control and reducted indicators of serious nonadherence (DKA hospital admissions) at treatment termination (1,2). Reductions in admissions were maintained 6 months later (2). The present study investigated the effects of MST on DKA admissions at the conclusion of the trial and related cost savings. RESEARCH DESIGN ANDMETHODS -A total of 127 adolescents with CPMC and their families were recruited from endocrinology clinics at Children's Hospital of Michigan between 1999 and 2004. Eligible youth were diagnosed with type 1 diabetes for at least 1 year, had an average A1C of Ն8% during the year before study entry, and were aged 10 -17 years. Mean Ϯ SD A1C at study entry was 11.3 Ϯ 2.3%. A total of 92% of the subjects used injected insulin, and 8% used insulin pumps. Mean Ϯ SD age was 13.2 Ϯ 2.0 years, and 63% of participants were African American.A total of 64 participants were randomly assigned to MST and 63 to a control group. All families received quarterly visits with a multidisciplinary diabetes team. MST-treatment families also received 6 months of therapy (mean 5.7 months). Families were followed for 24 months total. MST targeted adherence-related problems within the family and broader community systems (1,3). These systems included family (e.g., poor parental supervision and oversight of the youth's diabetes care completion), school (e.g., inadequate communication between parents and school personnel regarding the youth's health needs), and health care system factors (e.g., barriers to keeping clinic appointments due to problems with transportation or family disorganization).The number of DKA admissions was obtained from the treating hospital's information system for the 6-month window before study entry (ba...

Results suggest that gender differences in adherence may be attributed, in part, to gender differences in externalizing symptoms in urban youth with poor metabolic control. Interventions targeting these symptoms may be necessary to improve adherence and HbA1C in both boys and girls.

MST improved family relationships for youths with diabetes in two-parent but not in single-parent families. Objective outcomes related to diabetes were strongest for single-parent families. Other processes such as increased parental monitoring may have been responsible for improved health outcomes among these families.

The goal of the present study was to determine whether multisystemic therapy (MST) could decrease parental overestimation of adolescents' responsibility for completion of diabetes care. A randomized controlled trial was conducted with 127 adolescents with type 1 diabetes and their caregivers. Participants randomized to MST received treatment for approximately 6 months, and control participants received standard multidisciplinary care. Data were collected at baseline, posttreatment, and 12-month follow-up. In intent to treat analyses, participation in MST was associated with significant decreases in parental overestimation posttreatment and at 12-month follow-up. Tests for moderation found no significant effects of age, family composition, or ethnicity. Family delineation of responsibility for care is an important family process for diabetes management. An intensive homebased family therapy decreased parental overestimation of adolescent care completion among urban adolescents with chronically poorly controlled type 1 diabetes, a population often ignored in the research literature.