Skip to main content
Top

19-02-2018 | Psychological support | Review | Article

Family-Based Interventions Targeting Improvements in Health and Family Outcomes of Children and Adolescents with Type 1 Diabetes: a Systematic Review

Journal: Current Diabetes Reports

Authors: Marissa A. Feldman, Lindsay M. Anderson, Jenna B. Shapiro, Aneta M. Jedraszko, Meredyth Evans, Lindsey E. G. Weil, Kimberly P. Garza, Jill Weissberg-Benchell

Publisher: Springer US

Abstract

Purpose of Review

A systematic review was conducted of family-based interventions to improve glycemic control, adherence, and psychosocial outcomes in children and adolescents with type 1 diabetes (T1D). Electronic databases were searched for randomized controlled trials (RCTs) published since the seminal Diabetes Control and Compliance Trial (DCCT). Interventions are summarized and findings reviewed to help guide clinical practice and future research.

Recent Findings

Twenty-five RCTs are reviewed. The majority of studies (n = 15) focused on interventions targeting both children and adolescents and their caregivers and were delivered in diabetes clinics, outpatient settings, mental health clinics, or participants’ homes.

Summary

Family-based interventions for youth with T1D appear effective at improving diabetes and family-centered outcomes. Additional research is needed to examine the pathways to improvement in glycemic control, as outcomes were mixed. Future research should also involve measures beyond HbA1c given new markers for sustained health improvement and outcomes are being explored.

DOI: 10.1007/s11892-018-0981-9

Literature
    1. Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group. Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulindependent diabetes mellitus. J Pediatr. 1994;125:177–88.View Article
    2. Tamborlane WV, Gatcomb P, Held N, Ahern J. Implications of the DCCT results in treating children and adolescents with diabetes. Clinical. Diabetes. 1994;12(5):115–7.
    3. Hilliard ME, Wu YP, Rausch J, Dolan LM, Hood KK. Predictors of deteriorations in diabetes management and control in adolescents with type 1 diabetes. J Adolesc Health. 2013;52(1):28–34. https://​doi.​org/​10.​1016/​j.​jadohealth.​2012.​05.​009.View ArticlePubMed
    4. King PS, Berg CA, Butner J, Butler JM, Wiebe DJ. Longitudinal trajectories of parental involvement in type 1 diabetes and adolescents’ adherence. Health Psychol. 2014;33(5):424–32. https://​doi.​org/​10.​1037/​a0032804.View ArticlePubMed
    5. • Wiebe DJ, Chow CM, Palmer DL, Butner J, Butler JM, Osborn P, et al. Developmental processes associated with longitudinal declines in parental responsibility and adherence to type 1 diabetes management across adolescence. J Pediatr Psychol. 2014;39(5):532–41. Demonstrated that declines in adherence during adolescence may be mitigated by matching decline in parental responsibility with increasing self-efficacy View ArticlePubMedPubMed Central
    6. • Chiang JL, Kirkman MS, Laffel LM, Peters AL. Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes Care. 2014;37(7):2034–54. Summarizes data to provide guidance regarding the identification and treatment of T1D across the developmental lifespan. https://​doi.​org/​10.​2337/​dc14-1140.View ArticlePubMed
    7. Hsin O, La Greca AM, Valenzuela J, Moine CT, Delamater A. Adherence and glycemic control among Hispanic youth with type 1 diabetes: role of family involvement and acculturation. J Pediatr Psychol. 2009;35(2):156–66. https://​doi.​org/​10.​1093/​jpepsy/​jsp045.View ArticlePubMedPubMed Central
    8. Lewin AB, Heidgerken AD, Geffken GR, Williams LB, Storch EA, Gelfand KM, et al. The relation between family factors and metabolic control: the role of diabetes adherence. J Pediatr Psychol. 2005;31(2):174–83. https://​doi.​org/​10.​1093/​jpepsy/​jsj004.View ArticlePubMed
    9. Guo J, Whittemore R, He GP. The relationship between diabetes self-management and metabolic control in youth with type 1 diabetes: an integrative review. J Adv Nurs. 2011;67(11):2294–310. https://​doi.​org/​10.​1111/​j.​1365-2648.​2011.​05697.​x.View ArticlePubMed
    10. Hilliard ME, Holmes CS, Chen R, Maher K, Robinson E, Streisand R. Disentangling the roles of parental monitoring and family conflict in adolescents’ management of type 1 diabetes. Health Psychol. 2013;32(4):388–96. https://​doi.​org/​10.​1037/​a0027811.View ArticlePubMed
    11. Armour TA, Norris SL, Jack L, Zhang X, Fisher L. The effectiveness of family interventions in people with diabetes mellitus: a systematic review. Diabet Med. 2005;22(10):1295–305. https://​doi.​org/​10.​1111/​j.​1464-5491.​2005.​01618.​x.View ArticlePubMed
    12. Anderson BJ, Svoren B, Laffel L. Initiatives to promote effective self-care skills in children and adolescents with diabetes mellitus. Dis Manag Health Out. 2007;15(2):101–8. https://​doi.​org/​10.​2165/​00115677-200715020-00005.View Article
    13. • Hilliard ME, Powell PW, Anderson BJ. Evidence-based behavioral interventions to promote diabetes management in children, adolescents, and families. Am Psychol. 2016;71(7):590. Review of evidence-based behavioral interventions and an explanation of guiding behavioral principles that inform interventions for T1D and T2D601. https://​doi.​org/​10.​1037/​a0040359.View ArticlePubMedPubMed Central
    14. McBroom LA, Enriquez M. Review of family-centered interventions to enhance the health outcomes of children with type 1 diabetes. Diabetes Educ. 2009;35(3):428–38. https://​doi.​org/​10.​1177/​0145721709332814​.View ArticlePubMed
    15. Wysocki T, Harris MA, Greco P, Harvey LM, McDonell K, Elder Danda CL, et al. Social validity of support group and behavior theraphy intervetions for families of adolescents with insulin-dependent diabetes mellitu. J Pediatr Psychol. 1997;22(5):635–49. https://​doi.​org/​10.​1093/​jpepsy/​22.​5.​635.View ArticlePubMed
    16. Wysocki T, Miller KM, Greco P, Harris MA, Harvey LM, Taylor A, et al. Behavior therapy for families of adolescents with diabetes: effects on directly observed family interactions. Behav Ther. 1999;30(3):507–25. https://​doi.​org/​10.​1016/​S0005-7894(99)80022-7.View Article
    17. Wysocki T, Harris MA, Greco P, Bubb J, Danda CE, Harvey LM, et al. Randomized, controlled trial of behavior therapy for families of adolescents with insulin-dependent diabetes mellitus. J Pediatr Psychol. 2000;25(1):23–33. https://​doi.​org/​10.​1093/​jpepsy/​25.​1.​23.View ArticlePubMed
    18. Wysocki T, Greco P, Harris MA, Bubb J, White NH. Behavior therapy for families of adolescents with diabetes: maintenance of treatment effects. Diabetes Care. 2001;24(3):441–6. https://​doi.​org/​10.​2337/​diacare.​24.​3.​441.View ArticlePubMed
    19. Harris MA, Mertlich D. Piloting home-based behavioral family systems therapy for adolescents with poorly controlled diabetes. Child Health Care. 2003;32(1):65–79. https://​doi.​org/​10.​1207/​S15326888CHC3201​_​5.View Article
    20. Harris MA, Harris BS, Mertlich D. Brief report: in-home family therapy for adolescents with poorly controlled diabetes: failure to maintain benefits at 6-month follow-up. J Pediatr Psychol. 2005;30(8):683–8. https://​doi.​org/​10.​1093/​jpepsy/​jsi055.View ArticlePubMed
    21. Wysocki T, Harris MA, Buckloh LM, Mertlich D, Lochrie AS, Taylor A, et al. Effects of behavioral family systems therapy for diabetes on adolescents' family relationships, treatment adherence, and metabolic control. J Pediatr Psychol. 2006;31(9):928–38. https://​doi.​org/​10.​1093/​jpepsy/​jsj098.View ArticlePubMed
    22. Wysocki T, Harris MA, Buckloh LM, Mertlich D, Lochrie AS, Mauras N, et al. Randomized trial of behavioral family systems therapy for diabetes: maintenance of effects on diabetes outcomes in adolescents. Diabetes Care. 2007;30(3):555–60. https://​doi.​org/​10.​2337/​dc06-1613.View ArticlePubMed
    23. Wysocki T, Harris MA, Buckloh LM, Mertlich D, Lochrie AS, Taylor A, et al. Randomized, controlled trial of behavioral family systems therapy for diabetes: maintenance and generalization of effects on parent-adolescent communication. Behav Ther. 2008;39(1):33–46. https://​doi.​org/​10.​1016/​j.​beth.​2007.​04.​001.View ArticlePubMed
    24. Harris MA, Freeman KA, Duke DC. Seeing is believing: using Skype to improve diabetes outcomes in youth. Diabetes Care. 2015;38(8):1427–34. https://​doi.​org/​10.​2337/​dc14-2469.View ArticlePubMed
    25. Riley AR, Duke DC, Freeman KA, Hood KK, Harris MA. Depressive symptoms in a trial behavioral family systems therapy for diabetes: a post hoc analysis of change. Diabetes Care. 2015;38(8):1435–40. https://​doi.​org/​10.​2337/​dc14-2519.​ View ArticlePubMed
    26. • Duke DC, Wagner DV, Ulrich J, Freeman KA, Harris MA. Videoconferencing for teens with diabetes: family matters. J Diabetes Sci Technol. 2016;10(4):816–23. Telehealth behavioral intervention demonstrating improvement in family dynamics, and ultimately health outcomes for adolescents with T1D. https://​doi.​org/​10.​1177/​1932296816642577​.View ArticlePubMedPubMed Central
    27. Lehmkuhl HD, Storch EA, Cammarata C, Meyer K, Rahman O, Silverstein J, et al. Telehealth behavior therapy for the management of type 1 diabetes in adolescents. J diabetes Sci Technol. 2010;4(1):199–208. https://​doi.​org/​10.​1177/​1932296810004001​25.View ArticlePubMedPubMed Central
    28. Anderson BJ, Brackett J, Ho J, Laffel LM. An office-based intervention to maintain parent-adolescent teamwork in diabetes management. Impact on parent involvement, family conflict, and subsequent glycemic control. Diabetes Care. 1999;22(5):713–21. https://​doi.​org/​10.​2337/​diacare.​22.​5.​713.View ArticlePubMed
    29. Laffel LM, Vangsness L, Connell A, Goebel-Fabbri A, Butler D, Anderson BJ. Impact of ambulatory, family-focused teamwork intervention on glycemic control in youth with type 1 diabetes. J Pediatr. 2003;142(4):409–16. https://​doi.​org/​10.​1067/​mpd.​2003.​138.View ArticlePubMed
    30. Murphy HR, Wadham C, Hassler-Hurst J, Rayman G, Skinner TC. Randomized trial of a diabetes self-management education and family teamwork intervention in adolescents with type 1 diabetes. Diabet Med. 2012;29(8):e249–54. https://​doi.​org/​10.​1111/​j.​1464-5491.​2012.​03683.​x.View ArticlePubMed
    31. Murphy HR, Wadham C, Rayman G, Skinner TC. Approaches to integrating paediatric diabetes care and structured education: experiences from the Families, Adolescents, and Children’s Teamwork Study (FACTS). Diabet Med. 2007;24(11):1261–8. https://​doi.​org/​10.​1111/​j.​1464-5491.​2007.​02229.​x.View ArticlePubMed
    32. Ellis DA, Naar-King S, Chen X, Moltz K, Cunningham PB, Idalski-Carcone A. Multisystemic therapy compared to telephone support for youth with poorly controlled diabetes: findings from a randomized controlled trial. Ann Behav Med. 2012;44(2):207–15. https://​doi.​org/​10.​1007/​s12160-012-9378-1.View ArticlePubMedPubMed Central
    33. Ellis DA, Frey MA, Naar-King S, Templin T, Cunningham P, Cakan N. Use of multisystemic therapy to improve regimen adherence among adolescents with type 1 diabetes in chronic poor metabolic control. Diabetes Care. 2005;28(7):1604–10. https://​doi.​org/​10.​2337/​diacare.​28.​7.​1604.View ArticlePubMed
    34. Ellis DA, Frey MA, Naar-King S, Templin T, Cunningham PB, Cakan N. The effects of multisystemic therapy on diabetes stress among adolescents with chronically poorly controlled type 1 diabetes: findings from a randomized, controlled trial. Pediatrics. 2005;116(6):e826-e32.View Article
    35. Ellis DA, Templin T, Naar-King S, Frey MA, Cunningham PB, Podolski CL, et al. Multisystemic therapy for adolescents with poorly controlled type I diabetes: stability of treatment effects in a randomized controlled trial. J Consult Clin Psychol. 2007;75(1):168–74. https://​doi.​org/​10.​1037/​0022-006x.​75.​1.​168.View ArticlePubMed
    36. Nansel TR, Laffel LM, Haynie DL, Mehta SN, Lipsky LM, Volkening LK, et al. Improving dietary quality in youth with type 1 diabetes: randomized clinical trial of a family-based behavioral intervention. Int J Behav Nutr Phys Act. 2015;12(1):58. https://​doi.​org/​10.​1186/​s12966-015-0214-4.View ArticlePubMedPubMed Central
    37. Forsander G, Persson B, Sundelin J, Berglund E, Snellman K, Hellstrom R. Metabolic control in children with insulin-dependent diabetes mellitus 5y after diagnosis. Early detection of patients at risk for poor metabolic control. Acta Paediatr. 1998;87(8):857–64. https://​doi.​org/​10.​1111/​j.​1651-2227.​1998.​tb01551.​x.View ArticlePubMed
    38. Dougherty G, Schiffrin A, White D, Soderstrom L, Sufrategui M. Home-based management can achieve intensification cost-effectively in type I diabetes. Pediatrics. 1999;103(1):122–8. https://​doi.​org/​10.​1542/​peds.​103.​1.​122.View ArticlePubMed
    39. Forsander GA, Sundelin J, Persson B. Influence of the initial management regimen and family social situation on glycemic control and medical care in children with type I diabetes mellitus. Acta Paediatr. 2000;89(12):1462–8. https://​doi.​org/​10.​1111/​j.​1651-2227.​2000.​tb02777.​x.View ArticlePubMed
    40. Katz ML, Volkening LK, Butler DA, Anderson BJ, Laffel LM. Family-based psychoeducation and Care Ambassador intervention to improve glycemic control in youth with type 1 diabetes: a randomized trial. Pediatr Diabetes. 2014;15(2):142–50. https://​doi.​org/​10.​1111/​pedi.​12065.View ArticlePubMed
    41. Svoren BM, Butler D, Levine B-S, Anderson BJ, Laffel LM. Reducing acute adverse outcomes in youths with type 1 diabetes: a randomized, controlled trial. Pediatrics. 2003;112(4):914–22. https://​doi.​org/​10.​1542/​peds.​112.​4.​914.View ArticlePubMed
    42. Grey M, Whittemore R, Jaser S, Ambrosino J, Lindemann E, Liberti L, et al. Effects of coping skills training in school-age children with type 1 diabetes. Res Nurs Health. 2009;32(4):405–18. https://​doi.​org/​10.​1002/​nur.​20336.View ArticlePubMedPubMed Central
    43. Grey M, Jaser SS, Whittemore R, Jeon S, Lindemann E. Coping skills training for parents of children with type 1 diabetes: 12-month outcomes. Nurs Res. 2011;60(3):173–81. https://​doi.​org/​10.​1097/​NNR.​0b013e3182159c8f​.View ArticlePubMedPubMed Central
    44. • Holmes CS, Chen R, Mackey E, Grey M, Streisand R. Randomized clinical trial of clinic-integrated, low-intensity treatment to prevent deterioration of disease care in adolescents with type 1 diabetes. Diabetes Care. 2014;37(6):1535–43. RCT examining a brief behavioral intervention for adolescents and their parents to prevent expected decline in adherence and control typically seen during adolesence. https://​doi.​org/​10.​2337/​dc13-1053.View ArticlePubMedPubMed Central
    45. Rydén O, Nevander L, Johnsson P, Hansson K, Kronvall P, Sjoblad S, et al. Family therapy in poorly controlled juvenile IDDM: effects on diabetic control, self-evaluation and behavioural symptoms. Acta Paediatr. 1994;83(3):285–91. https://​doi.​org/​10.​1111/​j.​1651-2227.​1994.​tb18096.​x.View ArticlePubMed
    46. Hansson K, Rydén O, Johnsson P. Parent-rated family climate: a concomitant to metabolic control in juvenile IDDM? Fam Syst Med. 1994;12(4):405–13. https://​doi.​org/​10.​1037/​h0089272.View Article
    47. Kichler JC, Kaugars AS, Marik P, Nabors L, Alemzadeh R. Effectiveness of groups for adolescents with type 1 diabetes mellitus and their parents. Fam Syst Health. 2013;31(3):280–93. https://​doi.​org/​10.​1037/​a0033039.View ArticlePubMedPubMed Central
    48. Westrupp EM, Northam E, Lee KJ, Scratch SE, Cameron F. Reducing and preventing internalizing and externalizing behavior problems in children with type 1 diabetes: a randomized controlled trial of the Triple P-Positive Parenting Program. Pediatr Diabetes. 2015;16(7):554–63. https://​doi.​org/​10.​1111/​pedi.​12205.View ArticlePubMed
    49. Mackey ER, Herbert L, Monaghan M, Cogen F, Wang J, Streisand R. The feasibility of a pilot intervention for parents of young children newly diagnosed with type 1 diabetes. Clin Pract Pediatr Psychol. 2016;4(1):35–50. https://​doi.​org/​10.​1037/​cpp0000123.View ArticlePubMedPubMed Central
    50. Mackey ER, Struemph K, Powell PW, Chen R, Streisand R, Holmes CS. Maternal depressive symptoms and disease care status in youth with type 1 diabetes. Health Psychol. 2014;33(8):783–91. https://​doi.​org/​10.​1037/​hea0000066.View ArticlePubMedPubMed Central
    51. Jaser SS, Patel N, Rothman RL, Choi L, Whittemore R. Check it! A randomized pilot of a positive psychology intervention to improve adherence in adolescents with type 1 diabetes. Diabetes Educ. 2014;40(5):659–67. https://​doi.​org/​10.​1177/​0145721714535990​.​ View ArticlePubMedPubMed Central
    52. Husted GR, Thorsteinsson B, Esbensen BA, Gluud C, Winkel P, Hommel E, et al. Effect of guided self-determination youth intervention integrated into outpatient visits versus treatment as usual on glycemic control and life skills: a randomized clinical trial in adolescents with type 1 diabetes. Trials. 2014;15(1):321. https://​doi.​org/​10.​1186/​1745-6215-15-321.View ArticlePubMedPubMed Central
    53. Hampson SE, Skinner TC, Hart J, Storey L, Gage H, Foxcroft D, et al. Behavioral interventions for adolescents with type 1 diabetes: how effective are they? Diabetes Care. 2000;23(9):1416–22. https://​doi.​org/​10.​2337/​diacare.​23.​9.​1416.View ArticlePubMed
    54. Ellis D, Naar-King S, Templin T, Frey M, Cunningham P, Sheidow A, et al. Multisystemic therapy for adolescents with poorly controlled type 1 diabetes. Diabetes Care. 2008;31(9):1746–7. https://​doi.​org/​10.​2337/​dc07-2094.View ArticlePubMedPubMed Central
    55. Ellis DA, Naar-King S, Templin T, Frey MA, Cunningham PB. Improving health outcomes among youth with poorly controlled type I diabetes: the role of treatment fidelity in a randomized clinical trial of multisystemic therapy. J Fam. 2007;21(3):363.
    56. • Wright LA-C, Hirsch IB. Metrics beyond hemoglobin A1c in diabetes management: time in range, hypoglycemia, and other parameters. Diabetes Technol Ther. 2017;19(S2):S-16–26. Provides the latest examination of biomarkers for measuring individual blood glucose control, encouraging investigation and clinical utility beyond sole use of HbA1c. https://​doi.​org/​10.​1089/​dia.​2017.​0029.View Article

Be confident that your patient care is up to date

Medicine Matters is being incorporated into Springer Medicine, our new medical education platform. 

Alongside the news coverage and expert commentary you have come to expect from Medicine Matters diabetes, Springer Medicine's complimentary membership also provides access to articles from renowned journals and a broad range of Continuing Medical Education programs. Create your free account »