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.
DID YOU KNOW:
FDA orders warnings on the labels of Viagra, Levitra, and Cialis: The impotence drugs that some users have developed a form of blindness — while cautioning that it’s impossible to know if the pills are to blame. The Food and Drug Administration’s move comes as the agency is under intense pressure to investigate more aggressively and warn the public about drug side effects.
At issue is sudden vision loss when blood flow to the optic nerve is blocked, a condition called NAION or nonarteritic anterior ischemic optic neuropathy. NAION is considered one of the most common causes of sudden vision loss in older people, with anywhere from 1,000 to 6,000 cases a year. Moreover, risk factors include diabetes and heart disease, two of the leading causes of impotence. The FDA has 43 reports of NAION among the impotence drug users: 38 for Viagra, four for Cialis and one for Levitra. They include varying degrees of vision loss, including blindness. Those are rare numbers, given that Viagra alone has been used by 23 million men worldwide since its approval in 1998. "It is not possible to determine whether these oral medicines for erectile dysfunction were the cause," or whether other health conditions triggered NAION in the men, the FDA said in a statement last week. FDA report.