Original Articles
Coping skills training for youth with diabetes mellitus has long-lasting effects on metabolic control and quality of life,☆☆

https://doi.org/10.1067/mpd.2000.106568Get rights and content

Abstract

Objective: To determine whether initial effects on metabolic control and quality of life associated with a behavioral intervention combined with intensive diabetes management (IDM) can be sustained over 1 year in youth implementing intensive therapy regimens. Study design: Seventy-seven patients (43 females, 95% white) 12 to 20 years (mean = 14.2 ± 1.9; duration, 8.7 ± 3.9) electing to initiate IDM were randomly assigned to one of two groups: with or without coping skills training (CST), which consists of 6 small group sessions and monthly follow-up to help youth cope with their lives in the context of diabetes management; skills included social problem solving, cognitive behavior modification, and conflict resolution. Data were collected before the intervention and at 3, 6, and 12 months after the intervention by using the Self-Efficacy for Diabetes Scale, Children’s Depression Inventory, Issues in Coping with IDDM, and the Diabetes Quality of Life: Youth scales. Clinical data (glycosylated hemoglobin level, height, weight, adverse effects) were collected monthly. Results: The CST and IDM groups were comparable at baseline. CST subjects had lower glycosylated hemoglobin (P =.001) and better diabetes (P =.002) and medical (P =.04) self-efficacy, and less impact of diabetes on their quality of life (P =.005) than youth receiving IDM alone after 1 year. In males, CST did not affect adverse outcomes of IDM hypoglycemia, diabetic ketoacidosis, and weight gain, but CST decreased the incidence of weight gain (P =.05) and hypoglycemia in females (P =.03). Conclusions: The addition of behavioral intervention to IDM in adolescence results in improved metabolic control and quality of life over 1 year. (J Pediatr 2000;137:107-13)

Section snippets

Setting and Sample

Adolescents attending the Yale Children’s Diabetes Clinic were eligible for inclusion in the ABCs of Diabetes Study if they met the following criteria: (1) between the ages of 12 and 20 years; (2) no other health problem except for treated hypothyroidism; (3) treatment with insulin for at least 1 year; (4) recent HbA1c between 7.0% and 14% (normal, 4.3%-6.3%); (5) no severe hypoglycemic events within the past 6 months; and (6) in school grade appropriate to age within 1 year. Between November

Results

Metabolic control was measured at each monthly visit (Figure).

Figure. Metabolic control over 12 months (IDM/CST vs IDM alone; n = 75).

As with demographic and psychosocial variables, HbA1c levels were virtually identical at entry in the adolescents randomized to CST (9.1% ± 1.5%) and in the control group (9.2% ± 1.4%). In the entire sample, intensification of therapy in association with increased outpatient visits resulted in a significant fall in HbA1c levels (to 8.0% ± 1.2%, P <.001 vs

Discussion

Results of this study demonstrate that it is possible to translate DCCT recommendations regarding intensive management to a relatively large and representative group of adolescents with type 1 diabetes. Our patients’ ability to lower HbA1c levels to <8.0% (where normal is <6.3%) after 1 year compares favorably with the level of 8.2% (where normal is <6.0%) at 12 months in the DCCT. In that study 92 adolescents were treated intensively in 29 centers, whereas in this study 75 teenagers were

Acknowledgements

We acknowledge the work of the following people who participated in the clinical care of these patients: JoAnn Ahern and Patricia Gatcomb (diabetes nurse educators), Mary Savoye (dietician), and Sylvia Lavietes (social worker), as well as the following members of the research team who participated in the data collection and analysis: Joanne Mezgar, Delia Lakish, Ellen Shaw, Kelley Muldoon, Allison Oesterle, Elizabeth Perrone, Susan Sullivan-Bolyai, Sheri Kanner, and Chang Yu.

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  • Cited by (0)

    Supported by grants from National Institute of Nursing Research (RO1NR04009) and the Culpeper Foundation to Margaret Grey and the Yale Children’s Clinical Research Center (grant MO1-RR06022, General Clinical Research Centers Program, National Center for Research Resources, National Institutes of Health).

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    Reprint requests: Margaret Grey, DrPH, FAAN, CPNP, Independence Foundation Professor of Nursing, Associate Dean for Research Affairs, Yale University School of Nursing, 100 Church St South, PO Box 9740, New Haven, CT 06536-0740.

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