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Psychotherapy Helps Teens With Poorly Controlled Diabetes

Adolescents with type 1 diabetes in chronically poor metabolic control improve with multisystemic therapy, an intensive, home-based, family-centered psychotherapy. Dr. Deborah A. Ellis stated that, "Despite the fact that this group of patients has historically been viewed as very difficult to manage clinically. "Our study showed that families were willing to receive behavioral treatment when it was provided in their home and that such intensive behavioral interventions can result in improved outcomes."

According to Dr. Ellis, "adolescents receiving multisystemic therapy had significantly improved regimen adherence and metabolic control as well as reduced numbers of hospital admissions for diabetic ketoacidosis, as compared to a control group."

Randomized controlled trials have demonstrated the efficacy of multisystemic therapy for treating other challenging populations of adolescents including those with delinquency, substance abuse and psychiatric issues.

In their study, Dr. Ellis from Wayne State University in Detroit and colleagues randomly assigned 127 adolescents with a history of poorly controlled type 1 diabetes, defined as an HbA1c of 8% or greater for the past 12 months, to standard medical care only or to standard medical care plus 6 months of multisystemic evidence-based intervention targeting adherence-related problems.

Multisystemic therapy was successful in improving metabolic control, the team reports, with an average decline in HbA1c of 0.8%, which was both statistically significant and clinically meaningful, Dr. Ellis and colleagues note.

Multisystemic intervention led to significant improvements in the frequency of blood glucose testing as determined by blood glucose meters and 24-hour recall interviews.

"Frequent testing of blood glucose has been linked to better metabolic control and may therefore account for the improvements in metabolic control experienced by the [intervention] group," the investigators write.

This study shows that multisystemic therapy "holds promise in improving the diabetes management and metabolic control of adolescents with chronically poorly controlled type 1 diabetes," the authors conclude. However, longer post-intervention follow up is needed to determine whether the intervention has long-lasting effects, they note.
Diabetes Care 2005;28:1604-1610.

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