Adherence to IDDM Regimen in Urban Youth

描述（由申请人提供）：与青春期发育相关的治疗方案依从性和代谢控制的恶化是众所周知的。然而，一部分高风险的青少年糖尿病患者表现出更严重的依从性问题，慢性代谢控制不良（CPMC）就是证据。患有CPMC的青少年是短期和长期糖尿病并发症的高风险群体，因此是医疗资源和医疗保健费用的大量使用者。少数民族在青少年中也有过度的代表性。然而，这些青少年很少使用门诊保健服务，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是不成功的。此外，针对高危青少年的临床试验也很少。这个竞争性的更新申请代表了我们计划研究的下一步，以改善这些处于危险中的城市青年的健康结果。多系统治疗（MST）是一种密集的、以家庭为基础的家庭治疗，最初用于有严重精神健康问题的青少年及其家庭。我们的小组现在已经证明了MST在改善方案依从性和代谢控制以及减少患有CPMC的青少年DKA入院方面的功效。然而，我们的初步调查确定了两个变量，家庭中父母的数量和青少年超重，这两个变量显著影响了研究结果。该研究是一项随机对照试验，纳入170名参与者，比较强化版MST与电话支持（TS）干预治疗胰岛素控制型糖尿病青少年CPMC的有效性。MST- Enhanced （MST- ENHC）干预包括两个新模块：一个是坚持减肥计划，另一个是为单亲父母建立社会支持。因此，这项新试验将使我们能够测试，除了坚持更传统的糖尿病治疗方案外，坚持减肥建议是否能提高我们的HbA1c正常化能力，以及以社会支持为目标是否能提高单亲家庭依从性改善的稳定性。如果成功，MST将为易患糖尿病并发症和生活质量下降的高危人群提供即时援助。

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.