ADHERENCE TO IDDM REGIMEN IN URBAN YOUTH

描述（由申请人提供）：药物治疗依从性研究 这表明，相当大比例的人不遵守 为他们提供的治疗急性和慢性健康的建议 条件胰岛素依赖型糖尿病（IDDM）是一种慢性健康问题， 具有高度复杂的医疗方案的条件。有大量数据表明， 这表明，提高治疗依从性和代谢控制的人， 可延缓糖尿病并发症的发生。可惜那些 糖尿病自我管理和代谢水平最差的青少年胰岛素依赖型糖尿病 控制往往是最抗拒以医院为基础的医疗保健， 传统的教育/支持性干预。也面临 提高依从性的多重障碍，包括缺乏对以下方面的了解： 糖尿病、家庭解体和冲突、高度压力和 有限的社会支持和社区资源。多系统治疗 (MST)是一种以家庭和社区为基础的治疗模式， 用于有严重心理健康问题的青少年。MST拥有 被证明是“有效的”和高度可移植的类型， 最常提供护理的社区环境。初步数据表明 MST对青少年胰岛素依赖型糖尿病患者也是一种很有前途的治疗方法。的 本研究的目的是利用MST改善治疗 城市青少年胰岛素依赖型糖尿病患者的依从性和代谢控制， 糖化血红蛋白11%或以上。其他目的是确定 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，以测试关于MST治疗介质的假设 效果，并评估MST的成本效益与成本相比， 短期糖尿病并发症，如糖尿病酮症酸中毒（DKA）。的 本研究的实验设计是随机对照试验， 100名青少年的样本，其中50人将接受MST除了他们的 标准治疗，其中50人将只接受他们的胰岛素依赖型糖尿病的标准治疗。如果 成功的话，MST将为弱势群体提供即时援助， 糖尿病并发症和生活质量的高风险，也可能导致 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.