INTENSIVE THERAPY FOR IDDM IN YOUTH--OUTCOME PREDICTIONS

描述：糖尿病控制和并发症试验(DCCT)证实 胰岛素依赖型糖尿病的强化治疗(IT) 以接近正常的血糖为靶点延缓糖尿病的发病和进展 长期并发症。DCCT只招收上进心强的成年人和 目前还不清楚这种成功是否可以通过 更广泛的年轻人样本。信息技术的成本阻碍了它的传播； 需要更高效地交付IT的战略，以最大限度地提高 DCCT对公共卫生的影响。在每次DCCT评估中，约25% 常规治疗组青少年糖化血红蛋白水平低于8.0 %，而同样数量的IT患者没有。因此，一些患者 CT可以接近正常血糖，而其他人甚至不能用IT。 区分这些患者的因素的规范可以优化 DCCT临床翻译的资源分配和最大化 治疗从任何一种方法中受益。 这项建议建立在该团队的临床经验基础上，以前的研究 青年胰岛素依赖型糖尿病的心理问题及其在治疗中的合作 美国国立卫生研究院资助的项目。该应用程序基于概念模型，该模型 主张适合发展的自我护理自主性和IDDM 自我管理能力在人口统计因素的影响中起中介作用， 家庭功能和心理压力对糖尿病控制的影响。拥有的家庭 适度的自我管理能力被认为是最重要的 从IT中获益。160名患有IDDM的青少年及其父母的样本将是 随机到IT部门或继续接受他们的日常护理(UC；强化 常规疗法)。基准评估将包括相关的 人口、心理和家庭因素。将进行评估 每季度一次，为期18个月，包括对IDDM自我护理自主权的评估， 治疗依从性、家庭使用血糖数据、家庭互动 与卫生保健提供者一起，对IDDM和健康状况进行情感调整。 提出了广泛的措施以确保UC患者接触到NO 由于参与研究而增加了风险。UC的预测与IT治疗 响应将使用灵活的个人成长建模方法进行分析。 这项研究将具体说明影响IT的行为和心理因素 和UC响应，促进针对这些的干预措施的发展 用于选择患者的机制和有效的方案 它。

DESCRIPTION: The Diabetes Control and Complications Trial (DCCT) proved that Intensive Therapy (IT) for insulin-dependent diabetes mellitus targeting near-normoglycemia delays the onset and slows the progression of long-term complications. The DCCT enrolled only highly motivated adults and adolescents and it is unclear if this success can be duplicated with a broader sample of youth. The cost of IT impedes its dissemination; strategies of delivering IT more efficiently are needed to maximize the DCCT's public health impact. At each DCCT assessment, about 25 percent of adolescents in the Conventional Therapy group had HbA1c levels less than 8.0 percent, while a similar number of IT patients did not. Thus, some patients may approach normoglycemia with CT and others may not even with IT. Specification of factors differentiating these patients could optimize resource allocation for clinical translation of the DCCT and maximize treatment benefits from either approach. This proposal builds on the team's clinical experience, previous studies of psychological aspects of IDDM in youth and their collaboration on an NIH-funded project. The application is based on a conceptual model which asserts that developmentally appropriate self care autonomy and IDDM self-management competence mediate the influence of demographic factors, family function and psychological stress on diabetic control. Families with moderate self management competence are hypothesized to accrue the most benefit from IT. A sample of 160 youth with IDDM and their parents will be randomized to either IT or to continue in their usual care (UC; intensified conventional therapy). Baseline assessment will include pertinent demographic, psychological and family factors. Evaluations will occur quarterly for 18 months, including assessment of IDDM self care autonomy, treatment adherence, family use of blood glucose data, family interactions with health care providers, affective adjustment to IDDM and health status. Extensive measures are proposed to ensure that UC patients are exposed to no added risks due to study participation. Prediction of UC and IT treatment response will be analyzed using flexible individual growth modeling methods. The study will specify behavioral and psychological factors that mediate IT and UC response, promoting the development of interventions targeting these mechanisms and of well validated protocols for the selection of patients for IT.