This research aims to develop and test the efficacy of an intervention designed to improve self-management behaviors, glycemic control, and quality of life in a high risk group of minority youths with type 1 diabetes. This patient population is considered to be at high risk for eventual health complications and poor quality of life due to their chronic poor glycemic control. The morbidity and associated health care costs of poorly controlled diabetes are considerable and well documented. The findings from the landmark Diabetes Control and Complications Trial showed conclusively that attaining good glycemic control through intensified insulin regimens led to reduced risk of health complications, even among adolescents. Increased efforts to improve the glycemic control of young patients in poor control are therefore justified. We propose to develop a family-based program to improve self-management by increasing motivation, diabetes self-care behaviors, and family support, and improving glycemic control and quality of life in a group of 12-15 year-old minority youths. This patient group is considered at high risk due to their poor glycemic control, their minority and low socioeconomic status, and the high rate of single-parent families. Focus groups will be conducted to refine the intervention for cultural appropriateness and then the intervention will be pre-tested in additional focus groups. An innovative component of the intervention will be the use of motivational interviewing. A pilot study will then be conducted in which 60 children will be randomized to either receive or not receive the 6- month intervention, while all continue with standard medical care. Primary outcomes are measures of self-management behaviors and glycemic control obtained six and 12 months after the start of intervention. Secondary outcomes include measures of quality of life, diabetes family support and conflict, and self-efficacy. Potential mediators and moderators of response to intervention will also be examined. The results of this study will provide information concerning the efficacy of a new intervention to improve self-management in a high risk group of children with type 1 diabetes. Minority youth with type 1 diabetes are at high risk for eventual health complications and reduced quality of life due to their chronic poor glycemic control. This research will develop a new intervention to improve health outcomes for these patients. ? ? ?
