Research On Family Management Of Childhood Disease

儿童疾病家庭管理研究

• 批准号: 10691093
• 负责人: Tonja Nansel
• 金额: $ 0.7万
• 依托单位: EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10691093
• 关键词: Adherence; Adolescence; Age; Behavior; Behavior Therapy; Behavioral; Blood Glucose; Carbohydrates; Child Rearing; Childhood; Clinic; Clinic Visits; Clinical; Complex; Coping Skills; Data Analyses; Deterioration; Development; Diabetes Mellitus; Diabetic Ketoacidosis; Disease; Evaluation; Family; Geography; Glycosylated hemoglobin A; Goals; Health; Heart; Income; Injections; Insulin; Insulin Infusion Systems; Insulin-Dependent Diabetes Mellitus; Intake; Intervention; Kidney; Low income; Mental Depression; Nerve; Organ; Outcome; Parents; Participant; Persons; Physiological Processes; Problem Solving; Process; Randomized Clinical Trials; Randomized, Controlled Trials; Regulation; Research; Risk; Site; Socioeconomic Status; Structure; Testing; Typology; Visit; Work; Youth; base; clinical care; diabetes management; efficacy evaluation; efficacy testing; emerging adult; experience; eye blood vessel; family management; flexibility; follow-up; glycemic control; health disparity; improved; intervention effect; medical complication; preadolescence; prevent; primary outcome; psychosocial; secondary analysis; standard care

Management of type 1 diabetes is a complex, intensive task, including multiple daily insulin injections or use of an insulin pump, multiple daily blood glucose testing, regulation of carbohydrate intake, and problem-solving to correct excessive blood glucose fluctuations. Careful management is important to prevent short- and long-term complications, including diabetic ketoacidosis and damage to the heart, kidneys, nerves, eyes, blood vessels, and other organs. Owing to both psychosocial and physiological processes, glycemic control typically worsens across pre-adolescence and adolescence. Poor adaptation to diabetes during adolescence is likely to persist into early adulthood, accelerating the risks of long-term medical complications and psychiatric sequelae. The integration of behavioral management principles into clinical care may counter the deterioration in glycemic control that typically occurs during this developmental period. The Family Management of Type 1 Diabetes Study tested the efficacy of a clinic-integrated family-based intervention approach using the WE*CAN applied problem solving approach a semi-structured process incorporating assessment and specification of target behaviors, identification of barriers and motivators, collaborative setting of goals, facilitation of problem-solving and coping skills, and provision of follow-up and support. A multi-site randomized controlled trial was conducted at four geographically diverse diabetes centers. Participants were 390 youth with type 1 diabetes age 9-14 and their parents. The intervention was delivered at each routine clinic visit across the 2-year study (mean of 7 visits). The primary outcome was glycemic control (hemoglobin A1c; HbA1c) assessed at each clinic visit. Participants in the WE*CAN manage diabetes family-based behavioral intervention demonstrated a lesser deterioration in glycemic control than those receiving standard care; this effect was stronger among adolescents than pre-adolescents (Nansel et al. 2012 PMID 22392172). As adolescence is an especially difficult developmental period for improving diabetes management; these findings have substantial clinical implications. Another important contribution of this work was the examination of intervention effect across socioeconomic status. Extending from the inverse equity hypothesis, people experiencing lower income may be less equipped to benefit from behavioral interventions, inadvertently exacerbating health disparities; however, the efficacy of behavioral interventions across income groups is rarely examined. We found that the WE*CAN intervention was similarly effective in improving glycemic control among youth with type 1 diabetes across income levels suggesting that this flexible problem-solving approach may optimize impact across income groups (Nansel et al 2015 PMID 26231856). Secondary analyses from this data have advanced our understanding of the associations of parenting behaviors with health outcomes such as adherence, glycemic control, and depression (e.g., Thomas et al. 2018 PMID 29782387, Dempster et al 2019 PMID 30694403). Work in the current year extends these efforts by examining typologies of parenting and their associations with health outcomes and intervention effect (Temmen et al. 2022 doi.org/10.1111/pedi.13397).

1型糖尿病的管理是一项复杂而密集的任务，包括每日多次胰岛素注射或使用胰岛素泵，每日多次血糖检测，调节碳水化合物摄入量，以及解决问题以纠正过度的血糖波动。谨慎的管理对于预防短期和长期并发症非常重要，包括糖尿病酮症酸中毒和对心脏，肾脏，神经，眼睛，血管和其他器官的损害。由于心理社会和生理过程，血糖控制通常跨越青春期前和青春期。青少年时期对糖尿病的不良适应可能会持续到成年早期，从而加速长期医疗并发症和精神后遗症的风险。将行为管理原则整合到临床护理中可能会对抗通常发生在此发育期的血糖控制恶化。1型糖尿病家庭管理研究采用WE*CAN应用的问题解决方法测试了临床整合的家庭干预方法的有效性，该方法是一种半结构化的过程，包括评估和指定目标行为，识别障碍和激励因素，合作设定目标，促进解决问题和应对技能，以及提供随访和支持。 在四个地理位置不同的糖尿病中心进行了一项多中心随机对照试验。参与者是390名9-14岁的1型糖尿病患者及其父母。在为期2年的研究中，在每次常规门诊访视时进行干预（平均7次访视）。 主要结局是每次门诊访视时评估的血糖控制（血红蛋白A1 c; HbA 1c）。参与WE*CAN管理糖尿病家庭行为干预的受试者显示，血糖控制恶化程度低于接受标准治疗的受试者;青少年中的这一影响强于青少年前（Nansel et al. 2012 PMID 22392172）。由于青春期是改善糖尿病管理的一个特别困难的发展时期，这些发现具有重大的临床意义。这项工作的另一个重要贡献是检查了不同社会经济地位的干预效果。从逆公平假说延伸，经历较低收入的人可能不太具备从行为干预中受益的能力，无意中加剧了健康差距;然而，行为干预在收入群体中的有效性很少被研究。我们发现，WE*CAN干预在改善不同收入水平的1型糖尿病青年的血糖控制方面同样有效，这表明这种灵活的解决问题方法可以优化对不同收入群体的影响（Nansel et al 2015 PMID 26231856）。 对这些数据的二次分析促进了我们对养育行为与健康结果（如依从性、血糖控制和抑郁症）之间关系的理解（例如，托马斯等人，2018年PMID 29782387，Dempster等人，2019年PMID 30694403）。本年度的工作通过检查养育类型及其与健康结果和干预效果的关联来扩展这些努力（Temmen et al. 2022 doi.org/10.1111/pedi.13397）。

项目成果

A multisite trial of a clinic-integrated intervention for promoting family management of pediatric type 1 diabetes: feasibility and design.

促进儿科 1 型糖尿病家庭管理的临床综合干预的多中心试验：可行性和设计。

• DOI: 10.1111/j.1399-5448.2008.00448.x
• 发表时间: 2009-04
• 期刊: Pediatric diabetes
• 影响因子: 3.4
• 作者: Nansel TR;Anderson BJ;Laffel LM;Simons-Morton BG;Weissberg-Benchell J;Wysocki T;Iannotti RJ;Holmbeck GN;Hood KK;Lochrie AS
• 通讯作者: Lochrie AS

Long-term maintenance of treatment outcomes: diabetes personal trainer intervention for youth with type 1 diabetes.

• DOI: 10.2337/dc08-1968
• 发表时间: 2009-05
• 期刊: Diabetes care
• 影响因子: 16.2
• 作者: Nansel TR;Iannotti RJ;Simons-Morton BG;Plotnick LP;Clark LM;Zeitzoff L
• 通讯作者: Zeitzoff L

Reduction of hypoglycaemic events with a behavioural intervention: a randomized clinical trial for paediatric patients with Type 1 diabetes mellitus.

• DOI: 10.1111/dme.12744
• 发表时间: 2017-03
• 期刊: Diabetic medicine : a journal of the British Diabetic Association
• 作者: Gee BT;Nansel TR;Liu A
• 通讯作者: Liu A

Assessment of an illness-specific dimension of self-esteem in youths with type 1 diabetes.

评估患有 1 型糖尿病的青少年的疾病特定自尊维度。

• DOI: 10.1093/jpepsy/jsn078
• 发表时间: 2009
• 期刊: Journal of pediatric psychology
• 影响因子: 3.6
• 作者: Schneider,Stefan;Iannotti,RonaldJ;Nansel,TonjaR;Haynie,DeniseL;Sobel,DouglasO;Simons-Morton,Bruce
• 通讯作者: Simons-Morton,Bruce

Responsive parenting is associated with improved type 1 diabetes-related quality of life.

• DOI: 10.1111/j.1365-2214.2008.00855.x
• 发表时间: 2008-09
• 期刊: Child: care, health and development
• 作者: Botello-Harbaum M;Nansel T;Haynie DL;Iannotti RJ;Simons-Morton B
• 通讯作者: Simons-Morton B