Adherence to IDDM Regimen in Urban Youth

描述(由申请人提供)：众所周知，与青少年发育期相关的方案依从性和代谢控制的恶化。然而，患有糖尿病的高危青少年的一部分表现出更严重的依从性问题，慢性代谢控制不良(CPMC)就是明证。患有CPMC的青少年是糖尿病短期和长期并发症的高危群体，因此是医疗资源和医疗保健资金的大量使用者。在患有CPMC的青少年中，少数族裔的比例也过高。然而，这些青少年很少使用门诊健康服务，而传统的以办公室为基础的方法在改善这一群体的依从性和代谢控制方面基本上不成功。此外，针对高危青少年的临床试验很少。这一相互竞争的续签申请代表着我们为改善这类高危城市青年的健康结果而进行的方案研究的下一步。多系统疗法(MST)是一种强化的、以家庭为基础的家庭疗法，最初用于出现严重心理健康问题的青少年及其家人。我们小组现在已经证明了MST在改善CPMC青少年患者的方案依从性和代谢控制以及减少DKA入院方面的有效性。然而，我们的初步调查发现了两个变量，家庭中的父母数量和青少年超重，这两个变量显著影响了研究结果。这项拟议的研究是一项随机对照试验，招募了170名参与者，比较了MST增强版本与电话支持(TS)干预在治疗患有胰岛素管理的糖尿病的青少年CPMC方面的有效性。MST-Enhc(MST-ENHC)干预包括两个新模块：一个用于坚持减肥计划，另一个用于为单亲父母建立社会支持。因此，这项新的试验将允许我们测试，除了坚持糖尿病治疗方案的更传统方面外，是否有针对性地坚持减肥建议，是否会提高我们使HbA1c正常化的能力，以及是否有针对性的社会支持将提高单亲家庭坚持减肥建议的稳定性。如果成功，MST将立即为糖尿病并发症和生活质量下降的高危人群提供援助。

DESCRIPTION (provided by applicant): The deterioration in regimen adherence and metabolic control associated with the adolescent developmental period is well known. However, a subset of high-risk adolescents with diabetes demonstrate much more serious adherence problems, as evidenced by chronically poor metabolic control (CPMC). Adolescents with CPMC represent a group at high risk for short and long-term diabetes complications and are therefore heavy users of both medical resources and health care dollars. Minorities are also over-represented among adolescents with CPMC. However, such adolescents are infrequent users of outpatient health services and traditional office-based approaches have been largely unsuccessful in improving adherence and metabolic control in this group. In addition, there are few clinical trials targeting high-risk adolescents. This competing renewal application represents the next step in our programmatic research to improve health outcomes for such at-risk, urban youth. Multisystemic Therapy (MST) is an intensive, home-based family therapy originally used with youths presenting with serious mental health problems and their families. Our group has now demonstrated the efficacy of MST for the improvement of regimen adherence and metabolic control and reduction of DKA admissions among adolescents with CPMC. However, our initial investigation identified two variables, number of parents in the home and adolescent overweight,that significantly affected study outcomes. The proposed investigation is a randomized controlled trial enrolling 170 participants that compares the effectiveness of an enhanced version of MST as compared to a telephone support (TS) intervention to treat CPMC in adolescents with insulin-managed diabetes. The MST- Enhanced (MST- ENHC) intervention includes two new modules: one for adherence to a weight loss program and one for building social support for single parents. Therefore, this new trial will allow us to test whether targeting adherence to weight loss recommendations in addition to adherence to more traditional aspects of the diabetes regimen will improve our ability to normalize HbA1c and whether targeting social support will improve the stability of improvements in adherence for single-parent families. If successful, MST will provide immediate assistance to a vulnerable population at high risk for diabetes complications and reduced quality of life.