Poor management of type 1 diabetes mellitus (T1DM) may result in serious medical complications. Psychological intervention may improve adherence to medical regimens; however, access to trained professionals is limited, particularly in rural communities. Telehealth interventions may address this by allowing families to access services at home; however, little is known about the efficacy of such services.
Method:
This study presents results from a pilot trial of a randomized waitlist controlled trial of Telehealth Behavioral Therapy (TBT) for youths with T1DM. Primary outcome measures were adherence to the diabetes regimen, glycemic control, and level of family discord. Thirty-two youths (23 female) with T1DM (aged 9 to 17 years) and one parent or caregiver participated. Telehealth Behavioral Therapy sessions were conducted thrice weekly for 12 weeks by phone and lasted an average of 15 min each.
Results:
Results indicated that youths in treatment decreased their hemoglobin A1c by 0.74 compared to 0.09 in the waitlist, though this was not statistically significant. Youths in treatment reported increased unsupportive and decreased caring parental behaviors.
Conclusion:
Telehealth Behavioral Therapy improves access to knowledgeable providers and results in a clinically significant improvement in glycemic control. Despite some youths experiencing an increase in unsupportive parental behaviors, TBT is a promising method of service delivery that warrants further investigation.
DashiffCBartolucciAWallanderJAbdullatifH.The relationship of family structure, maternal employment, and family conflict with self-care adherence of adolescents with type 1 diabetes. Fam Syst Health.2005;23 (1): 66–79.
2.
KovacsMGoldstonDObroskyDSIyengarS.Prevalence and predictors of pervasive noncompliance with medical treatment among youths with insulin-dependent diabetes mellitus. J Am Acad Child Adolesc Psychiatry.1992;31 (6): 1112–9.
3.
KovacsMGoldstonDObroskyDSBonarLK.Psychiatric disorders in youths with IDDM: rates and risk factors. Diabetes Care.1997;20 (1): 36–44.
4.
Diabetes Control and Complications Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med.1993;329 (14): 977–86.
5.
NathanDMClearyPABacklundJYGenuthSMLachinJMOrchardTJRaskinPZinmanB, Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med.2005;353 (25): 2643–53.
6.
SilversteinJKlingensmithGCopelandKPlotnickLKaufmanFLaffelLDeebLGreyMAndersonBHolzmeisterLAClarkN, American Diabetes Association. Care of children and adolescents with type 1 diabetes: a statement of the American Diabetes Association. Diabetes Care.2005;28 (1): 186–212.
7.
SmithCPFirthDBennettSHowardCChisholmP.Ketoacidosis occurring in newly diagnosed and established diabetic children. Acta Paediatr.1998;87 (5): 537–41.
QuittnerALEspelageDLIevers-LandisCDrotarD.Measuring adherence to medical treatments in childhood chronic illness: Considering multiple methods and sources of information. J Clin Psychol Med Settings.2000;7 (1): 41–54.
10.
SvorenBMVolkeningLKButlerDAMorelandECAndersonBJLaffelLM.Temporal trends in the treatment of pediatric type 1 diabetes and impact on acute outcomes. J Pediatr.2007;150 (3): 279–85.
11.
AndersonBJSvorenBLaffelL.Initiatives to promote effective self-care skills in children and adolescents with diabetes mellitus. Dis Manag Health Outc.2007;15 (2): 101–8.
12.
KovacsMCharron-ProchownikDObroskyDS.A longitudinal study of biomedical and psychosocial predictors of multiple hospitalizations among young people with insulin-dependent diabetes mellitus. Diabet Med.1995;12 (2): 142–8.
13.
AuslanderWFThompsonSDreitzerDWhiteNHSantiagoJV.Disparity in glycemic control and adherence between African-American and Caucasian youth with diabetes. Family and community contexts. Diabetes Care.1997;20 (10): 1569–75.
14.
DelamaterAMAlbrechtDRPostellonDCGutaiJP. Racial differences in metabolic control of adolescents with type 1 diabetes mellitus. Diabetes Care.1991;14 (1): 20–5.
15.
GoldstonDBKovacsMObroskyDSIyengarS.A longitudinal study of life events and metabolic control among youths with insulin-dependent diabetes mellitus. Health Psychol.1995;14 (5): 409–14.
16.
CollinsWAGleasonTSesmaAJr.Internalization, autonomy, and relationships: development during adolescence. In: GrusecJEKuczynskiL, eds. Parenting and children's internalization of values: a handbook of contemporary theory. New York: Wiley; 1997.
17.
ThomasAMPetersonLGoldsteinD.Problem solving and diabetes regimen adherence by children and adolescents with IDDM in social pressure situations: a reflection of normal development. J Pediatr Psychol.1997;22 (4): 541–61.
18.
AndersonBJAuslanderWFJungKCMillerJPSantiagoJV.Assessing family sharing of diabetes responsibilities. J Pediatr Psychol.1990;15 (4): 477–92.
19.
LaGrecaAMFollansbeeDSkylerJS.Developmental and behavioral aspects of diabetes management in youngsters. Child Health Care.1990;19: 132–9.
20.
GeffkenGRLehmkuhlHWalkerKNStorchEAHeidgerkenADLewinAWilliamsLBSilversteinJ.Family functioning processes and diabetic ketoacidosis in youths with type one diabetes. Rehabil Psychol.2008;53 (2): 231–7.
21.
Weissberg-BenchellJGlasgowAMTynanWDWirtzPTurekJWardJ.Adolescent diabetes management and mismanagement. Diabetes Care.1995;18 (1): 77–82.
22.
WysockiTTaylorAHoughBSLinscheidTRYeatesKONaglieriJA.Deviation from developmentally appropriate self-care autonomy. Association with diabetes outcomes. Diabetes Care.1996;19 (2): 119–25.
23.
WysockiTHarrisMAGrecoPMertlichDBucklohL.Behavioral family systems therapy for adolescents with a chronic illness: treatment and implementation manual. Unpublished manuscript. 2001.
24.
WysockiTHarrisMABucklohLMMertlichDLochrieASTaylorASadlerMMaurasNWhiteNH.Effects of behavior family systems therapy for diabetes on adolescents' family relationships, treatment adherence, and metabolic control. J Pediatr Psychol.2006;31 (9): 928–38.
25.
GlasgowREAndersonBJ.Future directions for research on pediatric chronic disease management: lessons from diabetes. J Pediatr Psychol.1995;20 (4): 389–402.
26.
WolpertHAAndersonBJ. Management of diabetes: are doctors framing the benefits from the wrong perspective?BMJ.2001;323 (7319): 994–6.
27.
BalasEAJaffreyFKupermanGJBorenSABrownGDPinciroliFMitchellJA.Electronic communication with patients: evaluation of distance medicine technology. JAMA.1997;278 (2): 152–9.
28.
KlonoffDC.Diabetes and telemedicine: is the technology sound, effective, cost-effective, and practical?Diabetes Care.2003;26 (5): 1626–8.
29.
StammBHPeredniaDA.Evaluating psychosocial aspects of telemedicine and telehealth systems. Prof Psychol Res Pract.2000;31 (2): 184–9.
30.
HoltNCrawfordMA.Medical information service via telephone. The pioneer of physician consultation services. Ann N Y Acad Sci.1992;670: 155–62.
31.
MontoriVMHelgemoePKGuyattGHDeanDSLeungTWSmithSAKudvaYC.Telecare for patients with type 1 diabetes and inadequate glycemic control: a randomized controlled trial and meta-analysis. Diabetes Care.2004;27 (5): 1088–94.
32.
PietteJDWeinbergerMMcPheeSJ.The effect of automated calls with telephone nurse follow-up on patient-centered outcomes of diabetes care: a randomized, controlled trial. Med Care.2000;38 (2): 218–30.
33.
AdkinsJWStorchEALewinABWilliamsLSilversteinJHMalasanosTGeffkenGR.Home-based behavioral health intervention: use of a telehealth model to address poor adherence to type-1 diabetes medical regimens. Telemed J E Health.2006;12 (3): 370–2.
34.
GelfandKGeffkenGLewinAHeidgerkenAGroveMJMalasanosTSilversteinJ.An initial evaluation of the design of pediatric psychology consultation service with children with diabetes. J Child Health Care.2004;8 (2): 113–23.
35.
HeidgerkenADAdkinsJStorchEAWilliamsLLewinABSilversteinJHMalasanosTGeffkenGR.Telehealth intervention for adolescents with type 1 diabetes. J Pediatr.2006;148 (5): 707–8.
36.
HowellsLWilsonACSkinnerTCNewtonRMorrisADGreeneSA.A randomized controlled trial of the effect of negotiated telephone support on glycaemic control in young people with type 1 diabetes. Diabet Med.2002;19 (8): 643–8.
37.
NunnEKingBSmartCAndersonD.A randomized controlled trial of telephone calls to young patients with poorly controlled type 1 diabetes. Pediatr Diabetes.2006;7 (5): 254–9.
HarrisMAWysockiTSadlerMWilkinsonKHarveyLMBucklohLMMaurasNWhiteNH.Validation of a structured interview for the assessment of diabetes self-management. Diabetes Care.2000;23 (9): 1301–4.
40.
WallerDAChipmanJJHardyBWHightowerMSNorthAJWilliamsSBBabickAJ.Measuring diabetes-specific family support and its relation to metabolic control: a preliminary report. J Am Acad Child Psychiatry.1986;25 (3): 415–8.
41.
LewinABHeidgerkenADGeffkenGRWilliamsLBStorchEAGelfandKMSilversteinJH.The relation between family factors and metabolic control: the role of diabetes adherence. J Pediatr Psychol.2006;31 (2): 174–83.
42.
SchaferLCMcCaulKDGlasgowRE.Supportive and nonsupportive family behaviors: relationships to adherence and metabolic control in persons with type I diabetes. Diabetes Care.1986;9 (2): 179–85.
43.
McCaulKDGlasgowRESchaferLC.Diabetes regimen behaviors: predicting adherence. Med Care.1987;25 (9): 868–81.
44.
National Institutes of Mental Health. CGI (clinical global impression) scale. Psychopharmacol Bull.1985;21: 839–43.
45.
GuyW.ECDEU assessment manual for psychopharmacology, revised ed. DHEW Publication No. ADM 76–338. Washington DC: U.S. Department of Health, Education, and Welfare; 1976.
46.
CohenJ.Statistical power analysis for the behavioral sciences. 2nd ed.Hillsdale: Erlbaum; 1988.
