Translating Home-Based Interventions for Adolescents with Poorly Controlled T1D

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1型糖尿病(T1D)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)证明了这一点。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。尽管CPMC对青少年个体和社会的成本很高，但到目前为止，很少有随机对照试验针对这一人群。少数行为干预措施在改善患有CPMC的青年中的依从性和新陈代谢控制方面显示出有效性，其特点是招募比率很低，没有在有效性试验中进行测试，也没有传播到社区治疗环境中。我们使用了多系统疗法(MST)，这是一种以家庭为基础的强化心理疗法，用于治疗城市青年，主要是患有1型糖尿病和CPMC的少数民族青年。尽管MST在改善依从性和代谢控制以及减少糖尿病酮症酸中毒的入院方面具有很高的保留率和有效性，但向患有CPMC的年轻人提供MST的成本很高。干预措施的成本可能成为将循证干预措施转化为现实世界环境的障碍，特别是在卫生保健资金稀缺的情况下。这项拟议的研究是一项规划拨款，其中MST将由社区卫生工作者进行调整，并将与社区机构CHASS合作进行，CHASS是一家为底特律糖尿病患者提供医疗保健的社区机构。这种名为Fit Families(FF)的新干预措施将在一项试点随机对照试验中进行测试，以评估FF的可行性，最终确定结果衡量标准，估计干预对健康结果的影响大小(即青少年依从性、血糖控制、生活质量)，并确定与减少住院有关的潜在成本节省。这些步骤将最终确定干预内容和其他试验参数，为更大规模的R18传播试验做准备。如果成功，FF有可能改善糖尿病并发症和生活质量下降的高危弱势人群的健康结果，同时仍具有很高的可移植到现实世界治疗环境的能力。

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 type 1 diabetes (T1D) 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. Despite the high costs of CPMC to the individual adolescent and to society, few randomized controlled trials to date have targeted this population. The few behavioral interventions which have shown efficacy for improving adherence and metabolic control among youth with CPMC have also been characterized by very low recruitment rates, have not been tested in effectiveness trials, and have not been disseminated to community treatment settings. We have used Multisystemic Therapy (MST), an intensive, home-based psychotherapy, to treat urban, primarily minority youth with type 1 diabetes and CPMC. Despite MST's high retention rates and effectiveness for improving adherence and metabolic control and reducing admissions for diabetic ketoacidosis, costs to deliver MST to youth with CPMC are high. Costs of interventions can be a barrier to the translation of evidence-based interventions to real-world settings, especially in the context of scarce health care funding. The proposed study is a planning grant in which MST will be adapted for delivery by community health workers and will be conducted in collaboration with CHASS, a community agency providing health care to underserved residents of Detroit with diabetes. The new intervention, Fit Families (FF), will be tested in a pilot randomized controlled trial in order to evaluate FF feasibility, finalize outcome measures, estimate intervention effect sizes on health outcomes (i.e., youth adherence, glycemic control, quality of life) and determine potential cost savings associated with reduced hospital admissions. These steps will allow for finalization of intervention content and other trial parameters in preparation for a larger R18 dissemination trial. If successful, FF has the potential to improve health outcomes in a vulnerable population at high risk for diabetes complications and reduced quality of life, while still having high transportability to real-world treatment settings.