Using a prospective, randomized clinical trial design in youth with IDDM beginning intensive therapy, the investigators will determine whether a coping skills training program in conjunction with intensive diabetes management versus intensive management alone enhances metabolic control of diabetes as assessed by serial measurements of glycosylated hemoglobin A1c; psychosocial well-being as assessed by depression, self-efficacy, and quality of life; and, reduction in the rate of adverse events such as severe hypoglycemia and excessive weight gain. Secondarily, in comparison to baseline scores, they will examine the effects of intensive therapy with or without coping skills training on metabolic control of diabetes as assessed by serial hbA1c measurements; psychosocial well-being as assessed by depression, self-efficacy, and quality of life; and, the rate of adverse events such as severe hypoglycemia and excessive weight gain. Finally, we will determine how baseline clinical and psychosocial characteristics relate to the effectiveness of the coping skills training program as well as to intensive therapy. To achieve these aims, we will randomly assign a minimum of 120 youth between the ages of 13 and 20 electing to initiate intensive insulin therapy to two groups. All patients will receive intensive nursing management of intensive insulin therapy regimens as recommended by the Diabetes Control and Complications Trial (DCCT). One group will receive Coping Skills Training, which consists of a series of small group efforts designed to help youth cope with the management of their disease, combined with follow-up reinforcement of behaviors. Data will be collected pre and post intervention at 3, 6 and 12 months following using the Self-Efficacy for Diabetes Scale, Children's Depression Inventory, Issues in Coping with IDDM, and the Diabetes Quality of Life: Youth. Baseline data will include metabolic control (hbA1c) and other diabetes data. It is expected that this important and very timely study will yield valuable information to help other youth adopt intensive therapy regimens, and thereby decrease the potential for these youth to develop long-term complications of the disease.
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