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Intensive Home-Based Psychotherapy Aids Adolescents With Poor Diabetes Control

Multisystemic therapy, an intensive home-based family therapy initiative, reduces hospital admissions for diabetic ketoacidosis in adolescents with poorly controlled type 1 diabetes, results of a new study recently published. 

Dr. Deborah Ellis, of Wayne State University, Detroit, Michigan, examined whether multisystemic therapy (MST) reduced hospital admissions for diabetic ketoacidosis (DKA) in youths with poorly controlled diabetes over 24 months.

A total of 127 adolescents (mean age 13.2 years) were randomized to MST (n = 64) or a control group (n = 63). All participants received standard medical care with quarterly visits with a multidisciplinary diabetes team.

In addition, the MST group received 6 months of family therapy, targeting "adherence-related problems within the family and broader community systems."

During 24 months’ follow-up, there were significantly fewer cumulative hospital admissions for DKA among patients who received MST compared to control subjects (p = 0.019).

The cost to provide MST was $6943 per patient. However, there were substantial cost offsets from reductions in DKA hospital admissions.

"Preliminary evaluation suggests that control youth with DKA admissions accumulated sufficient costs over 24 months and that expenditures on MST may be justified by potential for savings," Dr. Ellis and colleagues explain. "The study demonstrates the potential for intensive behavioral interventions to reduce serious consequences of medication noncompliance in high-risk youth."

Diabetes Care 2008;31:1746-1747.