Original ArticlesCoping skills training for youth with diabetes mellitus has long-lasting effects on metabolic control and quality of life☆,☆☆
Section snippets
Setting and Sample
Adolescents attending the Yale Children’s Diabetes Clinic were eligible for inclusion in the ABCs of Diabetes Study if they met the following criteria: (1) between the ages of 12 and 20 years; (2) no other health problem except for treated hypothyroidism; (3) treatment with insulin for at least 1 year; (4) recent HbA1c between 7.0% and 14% (normal, 4.3%-6.3%); (5) no severe hypoglycemic events within the past 6 months; and (6) in school grade appropriate to age within 1 year. Between November
Results
Metabolic control was measured at each monthly visit (Figure).As with demographic and psychosocial variables, HbA1c levels were virtually identical at entry in the adolescents randomized to CST (9.1% ± 1.5%) and in the control group (9.2% ± 1.4%). In the entire sample, intensification of therapy in association with increased outpatient visits resulted in a significant fall in HbA1c levels (to 8.0% ± 1.2%, P <.001 vs
Discussion
Results of this study demonstrate that it is possible to translate DCCT recommendations regarding intensive management to a relatively large and representative group of adolescents with type 1 diabetes. Our patients’ ability to lower HbA1c levels to <8.0% (where normal is <6.3%) after 1 year compares favorably with the level of 8.2% (where normal is <6.0%) at 12 months in the DCCT. In that study 92 adolescents were treated intensively in 29 centers, whereas in this study 75 teenagers were
Acknowledgements
We acknowledge the work of the following people who participated in the clinical care of these patients: JoAnn Ahern and Patricia Gatcomb (diabetes nurse educators), Mary Savoye (dietician), and Sylvia Lavietes (social worker), as well as the following members of the research team who participated in the data collection and analysis: Joanne Mezgar, Delia Lakish, Ellen Shaw, Kelley Muldoon, Allison Oesterle, Elizabeth Perrone, Susan Sullivan-Bolyai, Sheri Kanner, and Chang Yu.
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Supported by grants from National Institute of Nursing Research (RO1NR04009) and the Culpeper Foundation to Margaret Grey and the Yale Children’s Clinical Research Center (grant MO1-RR06022, General Clinical Research Centers Program, National Center for Research Resources, National Institutes of Health).
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Reprint requests: Margaret Grey, DrPH, FAAN, CPNP, Independence Foundation Professor of Nursing, Associate Dean for Research Affairs, Yale University School of Nursing, 100 Church St South, PO Box 9740, New Haven, CT 06536-0740.