Long-Term Maintenance of Treatment Outcomes: Diabetes Personal Trainer Intervention for Youth With Type 1 Diabetes

Abstract

OBJECTIVE -To describe a 2-year follow-up of A1C outcomes of a self-regulation intervention for youth with type 1 diabetes.RESEARCH DESIGN AND METHODS -A total of 81 youths with type 1 diabetes ages 11-16 years were randomized to usual care versus a diabetes personal trainer intervention consisting of six self-monitoring, goal-setting, and problem-solving sessions with trained nonprofessionals. A1C data were obtained from medical records 2 years postintervention, and ANCOVA adjusting for age and baseline A1C was conducted.RESULTS -An overall intervention effect on A1C (8.93% control vs. 8.43% intervention; F ϭ 8.24, P ϭ 0.05) and a significant intervention-by-age interaction (F ϭ 9.88; P ϭ 0.002) were observed, indicating a greater effect among older than younger youths. Subgroup analyses demonstrated no treatment group differences among pre-/early adolescents but a significant difference in A1C among middle adolescents (9.61% control vs. 8.46% intervention; F ϭ 7.20, P ϭ 0.011).CONCLUSIONS -Findings indicate maintenance of intervention effects on A1C observed at 1-year follow-up. Diabetes Care 32:807-809, 2009E ffective behavioral programs designed to counter the deterioration in glycemic control that typically accompanies adolescence (1) could contribute substantially to improving diabetes management in this population, with the potential of impacting long-term management trajectories and health outcomes (2,3). The objective of this study was to assess 2-year A1C outcomes of a selfregulation intervention, delivered by nonprofessionals, for youth with type 1 diabetes. Short-term and 1-year outcomes have previously been reported; these showed a significant A1C effect and a treatment-by-age interaction, indicating a greater intervention effect among older than younger youths (4). The current analyses assessed whether these effects were maintained at 2-year follow-up. RESEARCH DESIGN AND METHODS -The study design and methods have previously been reported (4). Youth ages 11-16 years diagnosed with type 1 diabetes for at least 1 year and having no other major chronic illnesses or psychiatric diagnoses were recruited during routine visits at two pediatric endocrinology clinics serving a multistate area with urban, suburban, and rural populations. Of 113 eligible youth, 81 (72%) consented to participate. Data were collected by medical record review and inhome assessments with the youth and parents. Random assignment was stratified by age (11-13 vs. 14 -16 years) and A1C (Ͻ8.0 vs. Ն8.0%) for a total of four strata. The study protocol was approved by the National Institute of Child Health and Human Development institutional review board and the Western institutional review board (for participating clinical sites).The intervention consisted of six inperson semistructured sessions, supplemented with telephone calls, conducted over ϳ2 months by trained nonprofessionals (4). The approach was guided by principles of motivational interviewing, applied behavior analysis, and problem solving. Youth were assisted to identify are...

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Clinic-Integrated Behavioral Intervention for Families of Youth With Type 1 Diabetes: Randomized Clinical Trial

“…In that study, a significant improvement in glycemic control relative to the control group was obtained and maintained 2 years after intervention for the older participants but not for the younger participants. 27,43 The WE-CAN approach used in this study was delivered to parent and child together and incorporated greater attention to parentchild issues. We anticipated that these changes would make the intervention more effective for youth across the age range; however, findings in this study were virtually identical to those observed previously, suggesting that this approach may be most salient for youth who are beginning to take greater responsibility for their diabetes management.…”

“…Previous studies have shown that behavioral interventions hold promise for addressing these factors and improving diabetes management in youth. 17,18,[22][23][24][25][26][27][28][29][30][31] Findings have yet to result in the translation of behavioral intervention into standard clinical care, however. Barriers include reimbursement issues, staff training, and the reality that most behavioral interventions were not designed for integration into clinical care.…”

A systematic review of parent/peer-based group interventions for adolescents with type 1 diabetes: interventions based on theoretical/therapeutic frameworks

“…Two domains of outcome measures were extracted: diabetes functioning/medically performing/HbA1c and psychosocial functioning. Studies were excluded if they involved improving education alone, had no explicit theoretical background, 6,7,[44][45][46] were not a RCT, 15,[46][47][48][49][50] included children only 51,52 or adults 53 54 ) were checked in order to capture other relevant publications (see Appendix A for search terms at www.bjd-abcd.com).…”