Wysocki Tim, Harris Michael A, Buckloh Lisa M, Mertlich Debbie, Lochrie Amanda S, Mauras Nelly, White Neil H
Nemours Childrens Clinic, Department of Biomedical Research, 807 Children's Way, Jacksonville, FL 32207, USA.
Diabetes Care. 2007 Mar;30(3):555-60. doi: 10.2337/dc06-1613.
Studies showing that family communication and conflict resolution are critical to effective management of type 1 diabetes in adolescents have stimulated interest in evaluating psychological treatments targeting these processes. Previous trials have shown that Behavioral Family Systems Therapy (BFST) improved parent-adolescent relationships but not treatment adherence or glycemic control. This study evaluates a revised intervention, BFST for Diabetes (BFST-D), modified to achieve greater impact on diabetes-related family conflict, treatment adherence, and metabolic control.
A sample of 104 families of adolescents with inadequate control of type 1 diabetes was randomized to either remain in standard care (SC) or to augmentation of that regimen by 12 sessions of either a multifamily educational support (ES) group or 12 sessions of BFST-D over 6 months. Pertinent measures were collected at baseline and at follow-up evaluations at 6, 12, and 18 months.
BFST-D was significantly superior to both SC and ES in effects on A1C, while effects on treatment adherence and family conflict were equivocal. Improvement in A1C appeared to be mediated by improvement in treatment adherence. A significantly higher percentage of BFST-D youth achieved moderate or greater improvement (>0.5 SD) in treatment adherence compared with the SC group at each follow-up and the ES group at 6 and 18 months. Change in treatment adherence correlated significantly with change in A1C at each follow-up.
These results support the efficacy of BFST-D in improving A1C, but further research is needed to identify the mechanisms of this effect and to achieve cost-effective dissemination of the intervention.
研究表明，家庭沟通和冲突解决对于青少年1型糖尿病的有效管理至关重要，这激发了人们对评估针对这些过程的心理治疗方法的兴趣。先前的试验表明，行为家庭系统疗法（BFST）改善了亲子关系，但对治疗依从性或血糖控制没有效果。本研究评估了一种修订后的干预措施——糖尿病行为家庭系统疗法（BFST-D），该疗法经过改良，旨在对糖尿病相关的家庭冲突、治疗依从性和代谢控制产生更大影响。
选取104个1型糖尿病控制不佳的青少年家庭作为样本，将其随机分为两组，一组继续接受标准治疗（SC），另一组在6个月内通过参加12次多家庭教育支持（ES）小组或12次BFST-D来强化治疗方案。在基线以及6个月、12个月和18个月的随访评估中收集相关数据。
BFST-D在降低糖化血红蛋白（A1C）方面的效果显著优于SC和ES，而对治疗依从性和家庭冲突的影响不明确。A1C的改善似乎是由治疗依从性的改善介导的。在每次随访时，与SC组相比，BFST-D组中达到治疗依从性中度或更大改善（>0.5标准差）的青少年比例显著更高；在6个月和18个月时，与ES组相比也是如此。每次随访时，治疗依从性的变化与A1C的变化显著相关。
这些结果支持BFST-D在改善A1C方面的疗效，但需要进一步研究以确定这种效果的机制，并实现该干预措施的经济有效传播。
