Lehmkuhl Heather D, Storch Eric A, Cammarata Christina, Meyer Kara, Rahman Omar, Silverstein Janet, Malasanos Toree, Geffken Gary
Department of Psychology, Nationwide Children's Hospital, Columbus, Ohio 43205, USA.
J Diabetes Sci Technol. 2010 Jan 1;4(1):199-208. doi: 10.1177/193229681000400125.
Poor management of type 1 diabetes mellitus (T1DM) may result in serious medical complications. Psychological intervention may improve adherence to medical regimens; however, access to trained professionals is limited, particularly in rural communities. Telehealth interventions may address this by allowing families to access services at home; however, little is known about the efficacy of such services.
This study presents results from a pilot trial of a randomized waitlist controlled trial of Telehealth Behavioral Therapy (TBT) for youths with T1DM. Primary outcome measures were adherence to the diabetes regimen, glycemic control, and level of family discord. Thirty-two youths (23 female) with T1DM (aged 9 to 17 years) and one parent or caregiver participated. Telehealth Behavioral Therapy sessions were conducted thrice weekly for 12 weeks by phone and lasted an average of 15 min each.
Results indicated that youths in treatment decreased their hemoglobin A1c by 0.74 compared to 0.09 in the waitlist, though this was not statistically significant. Youths in treatment reported increased unsupportive and decreased caring parental behaviors.
Telehealth Behavioral Therapy improves access to knowledgeable providers and results in a clinically significant improvement in glycemic control. Despite some youths experiencing an increase in unsupportive parental behaviors, TBT is a promising method of service delivery that warrants further investigation.
1型糖尿病(T1DM)管理不善可能导致严重的医学并发症。心理干预可能会提高对医疗方案的依从性;然而,获得专业培训人员的机会有限,尤其是在农村社区。远程医疗干预可以通过让家庭在家中获得服务来解决这一问题;然而,对此类服务的效果知之甚少。
本研究展示了一项针对T1DM青少年的远程医疗行为疗法(TBT)随机等待名单对照试验的试点试验结果。主要结局指标为对糖尿病治疗方案的依从性、血糖控制和家庭不和程度。32名患有T1DM的青少年(23名女性)(年龄9至17岁)及其一名家长或照顾者参与了研究。远程医疗行为疗法课程通过电话每周进行三次,为期12周,每次平均持续15分钟。
结果表明,接受治疗的青少年糖化血红蛋白降低了0.74,而等待名单上的青少年仅降低了0.09,不过这一差异无统计学意义。接受治疗的青少年报告称,家长不支持行为增加,关爱行为减少。
远程医疗行为疗法增加了获得专业知识丰富的医疗服务提供者的机会,并在血糖控制方面带来了具有临床意义的改善。尽管一些青少年经历了家长不支持行为的增加,但TBT是一种有前景的服务提供方式,值得进一步研究。