ADHERENCE TO IDDM REGIMEN IN URBAN YOUTH

描述(由申请人提供)：对就医依从性的研究表明，相当大比例的人不遵守 给他们的治疗急慢性健康的建议 条件。胰岛素依赖型糖尿病是一种慢性健康疾病。 条件与高度复杂的医疗方案。大量数据表明 建议改善患者的治疗依从性和代谢控制 合并IDDM可延缓糖尿病并发症的发生。不幸的是，那些 患有最严重糖尿病的青少年IDDM患者自我管理和代谢 控制往往对以医院为基础的医疗保健最具抵抗力 传统的教育/支持性干预措施。他们还面临着 提高遵从性的多重障碍，包括缺乏以下方面的知识 糖尿病、家庭混乱和冲突、高度压力和 有限的社会支持和获得社区资源的机会。多系统疗法 (MST)是一种以家庭和社区为基础的治疗模式，以前 用于出现严重精神健康问题的青少年。MST有 已经被证明是“有效的”和高度可移植到类型的 最经常提供护理的社区环境。初步数据显示 对于患有IDDM的青少年来说，MST也是一种很有前途的方法。这个 本研究的目的是利用MST来提高治疗水平。 城市青少年IDDM和老年患者依从性及代谢控制 糖化血红蛋白11%或以上。其他目标是确定 MST对治疗依从性和代谢控制作用的稳定性 在两年的时间间隔内，测试关于MST治疗介体的假设 并评估MST与成本相比的成本效益 糖尿病的短期并发症，如糖尿病酮症酸中毒(DKA)。这个 本研究的实验设计为随机对照试验， 对100名青少年进行了抽样调查，其中50人除接受MST外，还将接受MST 其中50人将只得到他们的IDDM的标准护理。如果 如果成功，MST将立即向弱势群体提供援助 糖尿病并发症和生活质量的高风险，还可能导致 节省了大量的医疗费用。

DESCRIPTION (provided by applicant): Studies of medical treatment adherence suggest that substantial percentages of persons do not comply with recommendations given to them for the treatment of acute and chronic health conditions. Insulin dependent diabetes mellitus (IDDM) is a chronic health conditions with a highly complex medical regimen. Substantial data exist that suggest that improving treatment adherence and metabolic control in persons with IDDM can delay the onset of diabetes complications. Unfortunately, those adolescents with IDDM with the poorest diabetes self-management and metabolic control are often the most resistant to hospital-based health care and traditional educational/supportive interventions. They are also faced with multiple barriers to improved adherence, including lack of knowledge about diabetes, family disorganization and conflict, high levels of stress and limited social support and access to community resources. Multisystemic Therapy (MST) is a family and community-based treatment model which has previously been used with adolescents presenting with serious mental health problems. MST has been shown to be both "effective" and highly transportable to the types of community settings where care is most often provided. Preliminary data suggest that MST is a promising approach for adolescents with IDDM as well. The objective of the present study is to utilize MST to improve the treatment adherence and metabolic control of urban adolescents with IDDM and a glycoslated hemoglobin of 11 percent or above. Additional aims are to determine the stability of MST's effects on treatment adherence and metabolic control over a two year interval, to test hypotheses about mediators of MST treatment effects and to assess the cost-effectiveness of MST when compared to the costs of short-term diabetes complications such as diabetic ketoacidosis (DKA). The experimental design for the present study is a randomized controlled trial with a sample of 100 adolescents, 50 of whom will receive MST in addition to their standard care and 50 of whom will receive only standard care of their IDDM. If successful, MST will provide immediate assistance to a vulnerable population at high risk for diabetes complications and quality of life and may also result in substantial health care savings.