Research On Family Management Of Childhood Disease

1型糖尿病的管理是一项复杂而密集的任务，包括每天多次注射胰岛素或使用胰岛素泵，每天多次血糖检测，调节碳水化合物摄入量，以及解决问题以纠正过度的血糖波动。谨慎处理对于预防短期和长期并发症很重要，包括糖尿病酮症酸中毒和心脏、肾脏、神经、眼睛、血管和其他器官的损害。由于心理社会和生理过程，血糖控制通常在青春期前和青春期恶化。青春期对糖尿病的不良适应可能会持续到成年早期，从而加速长期医学并发症和精神后遗症的风险。将行为管理原则整合到临床护理中可能会抵消血糖控制恶化的影响，血糖控制恶化通常发生在这一发育时期。1型糖尿病的家庭管理研究测试了一种临床整合的以家庭为基础的干预方法的有效性，该方法使用的是我们*可以应用的问题解决方法，这是一种半结构化的过程，包括对目标行为的评估和规范、识别障碍和激励因素、协作设定目标、促进解决问题和应对技能以及提供后续和支持。 在四个地理位置不同的糖尿病中心进行了一项多点随机对照试验。参与者是390名患有1型糖尿病的9-14岁青年及其父母。在为期2年的研究中，在每次常规门诊就诊时进行干预(平均7次就诊)。 主要结果是在每次就诊时评估血糖控制情况(血红蛋白A1c；HbA1c)。我们可以管理糖尿病家庭行为干预的参与者显示，与接受标准护理的人相比，血糖控制的恶化程度较小；这种影响在青少年中比青春期前更强(Nansel等人)。2012年PMID 22392172)。由于青春期是改善糖尿病管理的特别困难的发育期，这些发现具有重大的临床意义。这项工作的另一个重要贡献是对不同社会经济地位的干预效果的检验。从反向公平假说引申出来，收入较低的人从行为干预中受益的准备可能较少，无意中加剧了健康差距；然而，行为干预在不同收入群体之间的有效性很少被检验。我们发现，We*Can干预措施在改善不同收入水平的1型糖尿病青少年血糖控制方面同样有效，这表明这种灵活的问题解决方法可能会优化对收入群体的影响(Nansel等人，2015PMID，26231856)。 来自这些数据的二次分析促进了我们对父母养育行为与健康结果之间的联系的理解，如坚持、血糖控制和抑郁(例如，Thomas等人。2018年PMID 29782387，邓普斯特等人2019年PMID 30694403)。本年度的工作通过研究父母教养的类型及其与健康结果和干预效果的关系来扩展这些努力(Temmen等人。2022doi.org/10.1111/pedi.13397)。

Management of type 1 diabetes is a complex, intensive task, including multiple daily insulin injections or use of an insulin pump, multiple daily blood glucose testing, regulation of carbohydrate intake, and problem-solving to correct excessive blood glucose fluctuations. Careful management is important to prevent short- and long-term complications, including diabetic ketoacidosis and damage to the heart, kidneys, nerves, eyes, blood vessels, and other organs. Owing to both psychosocial and physiological processes, glycemic control typically worsens across pre-adolescence and adolescence. Poor adaptation to diabetes during adolescence is likely to persist into early adulthood, accelerating the risks of long-term medical complications and psychiatric sequelae. The integration of behavioral management principles into clinical care may counter the deterioration in glycemic control that typically occurs during this developmental period. The Family Management of Type 1 Diabetes Study tested the efficacy of a clinic-integrated family-based intervention approach using the WE*CAN applied problem solving approach a semi-structured process incorporating assessment and specification of target behaviors, identification of barriers and motivators, collaborative setting of goals, facilitation of problem-solving and coping skills, and provision of follow-up and support. A multi-site randomized controlled trial was conducted at four geographically diverse diabetes centers. Participants were 390 youth with type 1 diabetes age 9-14 and their parents. The intervention was delivered at each routine clinic visit across the 2-year study (mean of 7 visits). The primary outcome was glycemic control (hemoglobin A1c; HbA1c) assessed at each clinic visit. Participants in the WE*CAN manage diabetes family-based behavioral intervention demonstrated a lesser deterioration in glycemic control than those receiving standard care; this effect was stronger among adolescents than pre-adolescents (Nansel et al. 2012 PMID 22392172). As adolescence is an especially difficult developmental period for improving diabetes management; these findings have substantial clinical implications. Another important contribution of this work was the examination of intervention effect across socioeconomic status. Extending from the inverse equity hypothesis, people experiencing lower income may be less equipped to benefit from behavioral interventions, inadvertently exacerbating health disparities; however, the efficacy of behavioral interventions across income groups is rarely examined. We found that the WE*CAN intervention was similarly effective in improving glycemic control among youth with type 1 diabetes across income levels suggesting that this flexible problem-solving approach may optimize impact across income groups (Nansel et al 2015 PMID 26231856). Secondary analyses from this data have advanced our understanding of the associations of parenting behaviors with health outcomes such as adherence, glycemic control, and depression (e.g., Thomas et al. 2018 PMID 29782387, Dempster et al 2019 PMID 30694403). Work in the current year extends these efforts by examining typologies of parenting and their associations with health outcomes and intervention effect (Temmen et al. 2022 doi.org/10.1111/pedi.13397).