Original ArticlesImpact of ambulatory, family-focused teamwork intervention on glycemic control in youth with type 1 diabetes*,**,*
Section snippets
Participants
This randomized, prospective study examined the impact of the family-focused teamwork intervention on glycemic control in 105 children/adolescents with T1DM who were patients in the Pediatric and Adolescent Unit at the Joslin Diabetes Center. Patient eligibility criteria included age 8 to 17 years; duration of T1DM longer than 2 months but less than 6 years; no concurring serious psychiatric or medical illness; residence in New England or New York; at least one outpatient medical visit at
Patient Characteristics
Taken together, the patients had a mean age of 12.1 ± 2.3 years at baseline, a mean duration of diabetes of 2.7 ± 1.6 years, and an average A1c of 8.36% ± 1.7%. The two groups (Table I) were comparable at entry with respect to age, duration of diabetes, sex distribution, and parent socioeconomic status.Empty Cell Study condition Empty Cell Teamwork intervention (n = 50) Standard care (n = 50) Age (y), mean ± SD 11.9 ± 2.4 12.2 ± 2.2 Duration (y), mean ± SD 2.7 ±
Discussion
Our family teamwork intervention demonstrated a significant difference in glycemic control after one year compared to standard multidisciplinary care in a relatively recent onset group of youth with T1DM. The A1c in the teamwork group did not deteriorate and was significantly lower than the A1c in the standard care group after one year. Multivariate analyses indicated that the significant difference in A1c resulted from the teamwork-mediated family involvement in diabetes management tasks.
Acknowledgements
We acknowledge contributions of the Pediatric Team at the Joslin Diabetes Center: Joan Mansfield, MD, Alyne Ricker, MD, Cindy Pasquarello, RN, BSN, CDE, Kristen Rice, RN, BSN, CDE, Kathleen Walsh, RN, CDE, Louise Crescenzi, and the pediatric endocrine fellows; we also acknowledge the research assistance of Abigail Mansfield and Amanda Fisher and the computer/statistical expertise of Linda Ficociello.
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Supported by a grant (DK-46887) from the National Institute of Diabetes, Digestive and Kidney Diseases, the Charles H. Hood Foundation, and the Katherine Adler Astrove Youth Education Fund.
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Intervention modules were created by the research team and are available by request from the corresponding author.
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Reprint requests: Lori Laffel, MD, MPH, Pediatric and Adolescent Unit, Joslin Diabetes Center, One Joslin Pl, Boston, MA 02215. E-mail: [email protected]