Family-based psychoeducation and care ambassador intervention to improve glycemic control in youth with type 1 diabetes: a randomized trial

Pediatric Diabetes | August 14, 2013

Katz ML et al. – Youth with type 1 diabetes frequently do not achieve glycemic targets. They aimed to improve glycemic control with a Care Ambassador (CA) and family–focused psychoeducational intervention. No differences in A1c were detected among the three groups at 2yr. The psychoeducational intervention was effective in maintaining or improving A1c and parent involvement in youth with suboptimal baseline glycemic control.

Methods

  • In a 2yr, randomized, clinical trial, they 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 2yr; secondary outcomes included maintaining parent involvement and avoiding deterioration in glycemic control.

Results

  • The authors’ studied 153 youth (56% female, median age 12.9yr) 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.

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