The Diabetes Control and Complications Trial (DCCT) heightened awareness of the critical importance of near-normal glycemic levels for preventing the complications of insulin-dependent diabetes mellitus (IDDM). However, for youth with IDDM, difficulties with adhering to the complex treatment regimen often interferes with optimal control. In the investigators' current work, they have implemented an outpatient, office-based family intervention to promote adolescent adherence and optimal control through the process of increased parental involvement with diabetes management tasks. To date, they have demonstrated (1) a significant positive impact of the intervention on metabolic control in patients with short duration of diabetes (less than 4 years), (2) significantly less deterioration in parent involvement in insulin tasks in families receiving the intervention, and (3) that increasing parent-adolescent sharing in the tasks of diabetes management did not increase family conflict. The research plan proposed builds on this promising approach, as well as on two areas of relevant theory and research which also support intervening early in the disease course. First, crisis intervention theories define an initial period of heightened susceptibility to behavioral interventions following a crisis such as the diagnosis of IDDM. Second, longitudinal studies of youth newly diagnosed with IDDM have demonstrated that adherence deteriorates over the first 4 years of diabetes and then seems to """"""""track"""""""", with children showing remarkable consistency in glycemic control as well as adherence over a decade of diabetes. The overall aim of this research is to study the impact of an outpatient Family Team Intervention on glycemic and adherence outcomes in 8-16 year olds during the first 4 years of IDDM. The proposed research will build on the investigators' current work and it is designed to assess whether the Team Intervention is superior to simple attention alone, or to routine medical care. This economical intervention may be generalized to a broad range of provider settings to help launch a new generation of patients with diabetes on a """"""""track"""""""" of optimal metabolic control and healthy adherence behaviors. The proposed research will determine the effectiveness of the Team Intervention on medical and behavioral outcomes and is targeted to recently diagnosed youth during the early years following diagnosis before behavior patterns of patient and family become resistant to change.
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