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

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 I diabetes (T1DM). Study design We randomly assigned 105 children and adolescents, 8 to 17 years of age, with T1DM for less than or equal to6 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 Ale was measured at each visit. Results Patients (n = 100) completed follow-up, (50 in TW and 50 in SC). At entry, Ale was 8.4% +/- 1.3% in TW and 8.3% +/- 1.0% in SC. After I year, Ale 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 Ale (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 less than or equal to6 years' duration. Successful family involvement may assist in the preservation of health and the prevention of long-term diabetes complications for youth with diabetes.