Effects of coping skills training in school‐age children with type 1 diabetes

Abstract

Children with type 1 diabetes are at risk for negative psychosocial and physiological outcomes, particularly as they enter adolescence. The purpose of this randomized trial (n=82) was to determine the effects, mediators, and moderators of a coping skills training intervention (n=53) for school-aged children compared to general diabetes education (n=29). Both groups improved over time, reporting lower impact of diabetes, better coping with diabetes, better diabetes self-efficacy, fewer depressive symptoms, and less parental control. Treatment modality (pump vs. injections) moderated intervention efficacy on select outcomes. Findings suggest that group-based interventions may be beneficial for this age group. Keywords coping skills training; child; type 1 diabetes Effects of Coping Skills Training in School-age Children with Type 1 DiabetesType 1 diabetes (T1D) is one of the most common severe chronic illnesses in children, affecting 1 in every 400 individuals under the age of 20, over 176,000 American youth Corresponding Author: Robin Whittemore, Yale School of Nursing, 100 Church Street South, New Haven, CT 06536-0740, robin.whittemore@yale.edu. NIH Public Access Author ManuscriptRes Nurs Health. Author manuscript; available in PMC 2010 August 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript(National Institute of Diabetes and Digestive and Kidney Disease, 2002). Diabetes is the seventh leading cause of death in the United States, and adults with T1D are twice as likely to die prematurely from complications compared to adults without T1D National Institute of Diabetes and Digestive and Kidney Disease, 2007). Management of T1D is demanding, requiring frequent monitoring of blood glucose levels, monitoring and controlling carbohydrate intake, daily insulin treatment (3-4 injections/day or infusion from a pump), and adjusting insulin dose to match diet and activity patterns (American Diabetes Association, 2008). Such an intensive treatment regimen and maintenance of near-normal glycemic control may delay or prevent long-term complications of T1D by 27-76% (Diabetes Control and Complications Trial [DCCT] Research Group, 1994). Interventions are needed to assist children and families in coping with the considerable demands of living with T1D. The purpose of this study was to evaluate the efficacy of a coping skills training (CST) intervention, specific to school-aged children and their parents, on metabolic control and psychosocial outcomes, and to examine mediators and moderators of these outcomes.Tasks of childhood development can compromise diabetes management. Metabolic control declines during adolescence (Travis, Brouhard, & Schreiner, 1987). Although the physiological changes of puberty contribute to insulin resistance, a premature transfer of responsibility for diabetes-related tasks from parents to children also may result in poor adherence and metabolic control (Anderson, Ho, Brackett, Finkelstein, & Laffel, 1997;Holmes et al., 2006;Schilling, Knafl, & Grey, 2006). As ch...

Coping Skills Training for Youths With Diabetes

“…Building on this work, Grey et al 42 studied whether providing coping skills training to preadolescent youths with type 1 diabetes would reduce problems as they enter adolescence. The purpose of this randomized trial (n = 82) was to determine the effects, mediators, and moderators of a coping skills training intervention for school-aged children compared to general diabetes education.…”

The Impact of Community Violence on School-Based Research

“…CST teaches cognitive behavioral skills such as problem solving, effective communication, conflict resolution, stress management, and behavior modification (Grey et al, 2009;Velsor-Friedrich et al, 2012). Institutional review board approval from authors' university and public school review board was obtained prior to study initiation.…”

Behavioral medicine interventions in diabetes

“…Glycemic control was not focused on as the primary outcome variable in every trial that reported significant improvements. The majority of trials demonstrated a significant effect on the improvement of coping, self-management behavior [36,38 ,40, 42,44], and diabetes-related self-efficacy [36,39,42,44,45] even when these were focused on as secondary outcome variables. Compared with control conditions, intervention participants improved significantly in terms of physical activity [38 ,44,45], awareness of hypoglycemia [39,44], HRQoL [37,38 ,42], and adherence to treatment [39,40].…”

“…In six RCTs glycemic control as measured by HbA1c was examined as the primary outcome [37,38 ,40,41,43 ,44]. In addition, changes in coping and self-management behavior [36,37,42], diabetes-related self-efficacy [36,39,42,44,45], treatment adherence [39,40], HRQoL [37,38 ,41,42,43 ], physical activity [38 ,43 ,44,45], dietary behavior [38 ,39,43 ], and BMI [40,42,43 ] were evaluated as treatment outcomes. Medical outcomes included blood pressure [38 ,43 ], cholesterol [38 ,43 ], and the frequency of hypoglycemia [39,41,43 ], whereas depressive symptoms and diabetes-related distress [39,40,43 ,44] were evaluated as psychological outcomes.…”

“…We classified the type of intervention as self-management interventions, if they were based on behavior-modification techniques combined with diabetes education or medical feedback. The following techniques were included: coping skills training [36,37], problem-solving [36,37,38 ,39,40], individual goal setting [38 ,39-42,43 ,44], conflict-resolution strategies [37,44], behavioral 'action plans' [42,45], motivational interviewing [39,41], and self-efficacy skills [39,42,44,45].…”