Genetics and Epidemiology Section, Joslin Diabetes Center, Boston, MA, 02215, USA.
Pediatr Diabetes. 2014 Mar;15(2):142-50. doi: 10.1111/pedi.12065. Epub 2013 Aug 5.
Youth with type 1 diabetes frequently do not achieve glycemic targets. We aimed to improve glycemic control with a Care Ambassador (CA) and family-focused psychoeducational intervention.
In a 2-yr, randomized, clinical trial, we compared three groups: (i) standard care, (ii) monthly outreach by a CA, and (iii) monthly outreach by a CA plus a quarterly clinic-based psychoeducational intervention. The psychoeducational intervention provided realistic expectations and problem-solving strategies related to family diabetes management. Data on diabetes management and A1c were collected, and participants completed surveys assessing parental involvement in management, diabetes-specific family conflict, and youth quality of life (QOL). The primary outcome was A1c at 2 yr; secondary outcomes included maintaining parent involvement and avoiding deterioration in glycemic control.
We studied 153 youth (56% female, median age 12.9 yr) with type 1 diabetes (mean A1c 8.4 ± 1.4%). There were no differences in A1c across treatment groups. Among youth with suboptimal baseline A1c ≥ 8%, more youth in the psychoeducation group maintained or improved their A1c and maintained or increased parent involvement than youth in the other two groups combined (77 vs. 52%, p = 0.03; 36 vs. 11%, p = 0.01, respectively) without negative impact on youth QOL or increased diabetes-specific family conflict.
No differences in A1c were detected among the three groups at 2 yr. The psychoeducational intervention was effective in maintaining or improving A1c and parent involvement in youth with suboptimal baseline glycemic control.
青少年 1 型糖尿病患者常无法达到血糖目标。我们旨在通过关爱大使（CA）和以家庭为中心的心理教育干预来改善血糖控制。
在一项为期 2 年的随机临床试验中，我们比较了三组：（i）标准护理，（ii）每月由 CA 进行家访，以及（iii）每月由 CA 家访加上每季度基于诊所的心理教育干预。心理教育干预提供了与家庭糖尿病管理相关的现实期望和解决问题的策略。收集了有关糖尿病管理和 A1c 的数据，参与者完成了调查，评估了父母对管理的参与度、糖尿病相关家庭冲突以及青少年生活质量（QOL）。主要结局是 2 年时的 A1c；次要结局包括维持父母的参与度和避免血糖控制恶化。
我们研究了 153 名患有 1 型糖尿病的青少年（56%为女性，中位年龄为 12.9 岁）（平均 A1c 为 8.4 ± 1.4%）。三组之间的 A1c 无差异。在基线 A1c 不达标（≥8%）的青少年中，与其他两组相比，更多接受心理教育的青少年维持或改善了他们的 A1c 水平，维持或增加了父母的参与度（分别为 77%比 52%，p=0.03；36%比 11%，p=0.01），而不会对青少年的 QOL 或增加糖尿病相关家庭冲突产生负面影响。
在 2 年时，三组之间的 A1c 没有差异。心理教育干预在维持或改善血糖控制不达标青少年的 A1c 和父母参与度方面是有效的。
