Testing MST to Improve Adherence Among Youth With Chronic Poor Metabolic Control

Substantial data exists to demonstrate that improving metabolic control in persons with Type 1 diabetes mellitus (T1DM) can delay the onset of diabetes complications and reverse some existing complications as well. Unfortunately, those adolescents with T1DM who are at highest risk for diabetes complications are often the most resistant to hospital based care and traditional education/ supportive interventions. They are also faced with multiple barriers to improved metabolic control, which may include lack of knowledge about diabetes, family disorganization and disengagement, high levels of stress and an unhealthy lifestyle. Multisystemic Therapy (MST), a flexible and home-based therapeutic intervention originally designed for use with mental health populations, seems to be a promising approach to providing diabetic adolescents with the ability to engage in consistent and attentive illness management.

The study recruited a sample of 127 adolescents in poor metabolic control and randomly assigned them to either the treatment intervention, MST plus standard medical care, or standard medical care alone. Families randomized to MST received intensive, home-based family therapy for approximately six months. Families completed data collection at baseline and then again at 7, 12 18 and 24 months after study entry.

Inclusion criteria

• a current hemoglobin A1c(HbA1c) of >8.0%
• an average HbA1c of >8.0% during the past year
• diagnosed with Type 1 diabetes for at least one year
• reside in the metro Detroit tri-county area

Exclusion criteria

• severe mental impairment/thought disorder
• non-English speaking patient/parent
• co-morbid major medical condition such as cystic fibrosis