Original Articles
Impact of ambulatory, family-focused teamwork intervention on glycemic control in youth with type 1 diabetes*,**,*

Presented in part at the 62nd Annual Meeting and Scientific Sessions of the American Diabetes Association, San Francisco, California, June 2002.
https://doi.org/10.1067/mpd.2003.138Get rights and content

Abstract

Objective To evaluate an ambulatory, family-focused intervention aimed at optimizing glycemic control, minimizing diabetes-related family conflict (DFC), and maintaining quality of life in youth with type 1 diabetes (T1DM). Study design We randomly assigned 105 children and adolescents, 8 to 17 years of age, with T1DM for ≤6 years, to a family-focused teamwork (TW) intervention or to standard multidisciplinary diabetes care (SC). Patients in both study groups were seen at 3- to 4-month intervals and were followed prospectively for 1 year. Measures of family involvement in diabetes tasks, DFC, and quality of life were performed at baseline and after 1 year. Hemoglobin A1c was measured at each visit. Results Patients (n = 100) completed follow-up, (50 in TW and 50 in SC). At entry, A1c was 8.4% ± 1.3% in TW and 8.3% ± 1.0% in SC. After 1 year, A1c was 8.2% ± 1.1% in TW compared with 8.7% ± 1.5% in SC (P <.05). Both groups had similar frequencies of blood glucose monitoring (BGM) and insulin dosing. Families exposed to the TW intervention maintained or increased family involvement significantly more than families exposed to SC (P =.05). In multivariate analysis, the TW intervention and the daily frequency of BGM significantly predicted A1c (R 2 = 0.17, P =.05). Despite increased family involvement, the TW group reported no increase in DFC or decrease in quality of life. Conclusions The ambulatory TW intervention prevented the expected deterioration in glycemic control seen with SC in youths with T1DM of ≤6 years' duration. Successful family involvement may assist in the preservation of health and the prevention of long-term diabetes complications for youth with diabetes. (J Pediatr 2003;142:409-16)

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.

. Baseline patient characteristics by study condition (n = 100)

Empty CellStudy condition
Empty CellTeamwork intervention (n = 50)Standard care (n = 50)
Age (y), mean ± SD11.9 ± 2.412.2 ± 2.2
Duration (y), mean ± SD2.7 ±

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.

    **

    Intervention modules were created by the research team and are available by request from the corresponding author.

    *

    Reprint requests: Lori Laffel, MD, MPH, Pediatric and Adolescent Unit, Joslin Diabetes Center, One Joslin Pl, Boston, MA 02215. E-mail: [email protected]

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