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Multisystemic therapy compared to telephone support for youth with poorly controlled diabetes: findings from a randomized controlled trial.

ABSTRACT: Few interventions have effectively improved health outcomes among youth with diabetes in chronic poor metabolic control.This study aims to determine whether multisystemic therapy (MST), an intensive, home-based, tailored family treatment, was superior to weekly telephone support for improving regimen adherence and metabolic control among adolescents with chronic poor metabolic control.A randomized controlled trial was conducted with 146 adolescents with types 1 or 2 diabetes. Data were collected at baseline, 7 months (treatment termination), and 12 months (6 months follow-up).Adolescents receiving MST had significantly improved metabolic control at 7 (1.01 % decrease) and 12 months (0.74 % decrease) compared to adolescents in telephone support. Parents of adolescents receiving MST reported significant improvements in adolescent adherence. However, adolescent-reported adherence was unchanged.MST improved health outcomes among adolescents with chronic poor metabolic control when compared to telephone support. Home-based approaches may provide a viable means to improve access to behavioral interventions for such youth.

SUBMITTER: Ellis DA

PROVIDER: S-EPMC3443313 | biostudies-literature | 2012 Oct

REPOSITORIES: biostudies-literature

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Multisystemic therapy compared to telephone support for youth with poorly controlled diabetes: findings from a randomized controlled trial.

Ellis Deborah A DA Naar-King Sylvie S Chen Xinguang X Moltz Kathleen K Cunningham Phillippe B PB Idalski-Carcone April A

Annals of behavioral medicine : a publication of the Society of Behavioral Medicine 20121001 2

<h4>Background</h4>Few interventions have effectively improved health outcomes among youth with diabetes in chronic poor metabolic control.<h4>Purpose</h4>This study aims to determine whether multisystemic therapy (MST), an intensive, home-based, tailored family treatment, was superior to weekly telephone support for improving regimen adherence and metabolic control among adolescents with chronic poor metabolic control.<h4>Methods</h4>A randomized controlled trial was conducted with 146 adolesce ...[more]

PMID: 22644587

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Project description:IntroductionThe hemochorial placenta provides a critical barrier at the maternal-fetal interface to modulate maternal immune tolerance and enable gas and nutrient exchange between mother and conceptus. Pregnancy outcomes are adversely affected by diabetes mellitus; however, the effects of poorly controlled diabetes on placental formation, and subsequently fetal development, are not fully understood.Research design and methodsStreptozotocin was used to induce hyperglycemia in pregnant rats for the purpose of investigating the impact of poorly controlled diabetes on placental formation and fetal development. The experimental paradigm of hypoxia exposure in the pregnant rat was also used to assess properties of placental plasticity. Euglycemic and hyperglycemic rats were exposed to ambient conditions (~21% oxygen) or hypoxia (10.5% oxygen) beginning on gestation day (gd) 6.5 and sacrificed on gd 13.5. To determine whether the interaction of hyperglycemia and hypoxia was directly altering trophoblast lineage development, rat trophoblast stem (TS) cells were cultured in high glucose (25 mM) and/or exposed to low oxygen (0.5% to 1.5%).ResultsDiabetes caused placentomegaly and placental malformation, decreasing placental efficiency and fetal size. Elevated glucose disrupted rat TS cell differentiation in vitro. Evidence of altered trophoblast differentiation was also observed in vivo, as hyperglycemia affected the junctional zone transcriptome and interfered with intrauterine trophoblast invasion and uterine spiral artery remodeling. When exposed to hypoxia, hyperglycemic rats showed decreased proliferation and ectoplacental cone development on gd 9.5 and complete pregnancy loss by gd 13.5. Furthermore, elevated glucose concentrations inhibited TS cell responses to hypoxia in vitro.ConclusionsOverall, these results indicate that alterations in placental development, efficiency, and plasticity could contribute to the suboptimal fetal outcomes in offspring from pregnancies complicated by poorly controlled diabetes.

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Multisystemic therapy compared to telephone support for youth with poorly controlled diabetes: findings from a randomized controlled trial.

Publications

Multisystemic therapy compared to telephone support for youth with poorly controlled diabetes: findings from a randomized controlled trial.

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