Diabetes in Adolescence: Effects of Multifamily Group Intervention and Parent Simulation of Diabetes

Abstract

Insulin-dependent diabetes mellitus (IDDM) is a complex, chronic disease that is difficult to control during adolescence. This study evaluated the effects of a 6-week, family-oriented, group intervention on adolescents' metabolic control and psychosocial and family functioning. Thirty-two families were randomly assigned to one of three groups: multifamily (MF), multifamily plus parent simulation of diabetes (MF + S), and control (C). Outcome measures included glycosylated hemoglobin (Hb Al); perceptions of diabetes; estimates of youngsters' self-care; and family functioning. Adolescents in the MF + S group displayed significant decrements in Hb Al, and adolescents in both intervention groups reported more positive perceptions of a "teen-ager with diabetes" at posttreatment, relative to controls. Adolescents participating in smaller family groups demonstrated clinically significant improvements in Hb Al that were maintained at 6-month follow-up. Parent reports suggested that adolescents in the intervention groups improved their diabetes care. Findings support the use of multifamily groups plus parent simulation of diabetes as an intervention strategy for adolescents with IDDM.

Adolescent views of diabetes-related parent conflict and support: a focus group analysis

“…Focus group participants reported parental familiarity with diabetes and its complexities as contributing to this understanding. Past research has shown that an intervention involving parental simulation of diabetes management was more effective than an intervention without this simulation, perhaps related to a more empathic understanding of the complexities of diabetes [37]. Anderson et al [27] used written materials during scheduled medical appointments to help parents understand the multiple causes of high and low blood glucose levels, to have realistic expectations for blood glucose levels, and to remain involved with insulin injections and blood glucose monitoring without blaming and shaming the adolescent.…”

Care of Children and Adolescents With Type 1 Diabetes

“…Multifamily group intervention with parent simulation of diabetes (231) and Behavioral Family Systems Therapy (232) have been demonstrated to improve parent and child outcomes. As parents and children negotiate responsibilities in diabetes management, and as these responsibilities change over time, it is likely that parentadolescent conflict will develop.…”

Commonalities in Effective Behavioral Interventions for Children and Adolescents With Type 1 Diabetes: A Review of Reviews

“…Specifically, adherence, psychological factors, and family factors have all been targeted in efforts to promote optimal diabetes outcomes in youth. 10,11,[18][19][20][21][22][23][24][25][26] For youth with diabetes, these factors are necessarily intertwined. Type 1 diabetes is embedded in the individual and family system, making nearly every component of daily life part of the diabetes lifestyle.…”

“…Their statistically rigorous approach highlighted certain treatments, particularly those with a theoretical foundation, that offered greater promise in terms of psychological and physiological outcomes. [10][11][12] Further, they were able to provide a quantitative examination of the public health impact of these interventions through use of the RE-AIM framework. 13 However, their overarching conclusion about behavioral interventions for adolescents with type 1 diabetes was that they offered small to medium beneficial effects across these outcomes.…”