The deterioration in regimen adherence and metabolic control associated with the adolescent developmental period is well known. However, a subset of high-risk adolescents with type 1 diabetes (T1D) demonstrate much more serious adherence problems, as evidenced by chronically poor metabolic control (CPMC). Adolescents with CPMC represent a group at high risk for short and long-term diabetes complications and are therefore heavy users of both medical resources and health care dollars. Minorities are also over-represented among adolescents with CPMC. Despite the high costs of CPMC to the individual adolescent and to society, few randomized controlled trials to date have targeted this population. The few behavioral interventions which have shown efficacy for improving adherence and metabolic control among youth with CPMC have also been characterized by very low recruitment rates, have not been tested in effectiveness trials, and have not been disseminated to community treatment settings. We have used Multisystemic Therapy (MST), an intensive, home-based psychotherapy, to treat urban, primarily minority youth with type 1 diabetes and CPMC. Despite MST's high retention rates and effectiveness for improving adherence and metabolic control and reducing admissions for diabetic ketoacidosis, costs to deliver MST to youth with CPMC are high. Costs of interventions can be a barrier to the translation of evidence-based interventions to real-world settings, especially in the context of scarce health care funding. The proposed study is a planning grant in which MST will be adapted for delivery by community health workers and will be conducted in collaboration with CHASS, a community agency providing health care to underserved residents of Detroit with diabetes. The new intervention, Fit Families (FF), will be tested in a pilot randomized controlled trial in order to evaluate FF feasibility, finalize outcome measures, estimate intervention effect sizes on health outcomes (i.e., youth adherence, glycemic control, quality of life) and determine potential cost savings associated with reduced hospital admissions. These steps will allow for finalization of intervention content and other trial parameters in preparation for a larger R18 dissemination trial. If successful, FF has the potential to improve health outcomes in a vulnerable population at high risk for diabetes complications and reduced quality of life, while still having high transportability to real-world treatment settings.
Adolescents with T1D and chronic poor metabolic control are at high risk for short and long-term diabetes complications and are heavy users of both medical resources and health care dollars. The purpose of the proposed study is to collaborate with a community agency to develop and test an intervention, Fit Families, that uses the core components of our previously successful home-based family treatment, but that can delivered by lower cost community health workers. If successful, Fit Families could improve health outcomes in a vulnerable population at high risk for diabetes complications, and could be translated to real-world treatment settings.
