Multisystemic Therapy for Adolescents With Poorly Controlled Type 1 Diabetes
Reduced diabetic ketoacidosis admissions and related costs over 24 months
- Deborah Ellis, PHD1,
- Sylvie Naar-King, PHD1,
- Thomas Templin, PHD1,
- Maureen Frey, PHD1,
- Phillippe Cunningham, PHD2,
- Ashli Sheidow, PHD2,
- Nedim Cakan, MD1 and
- April Idalski, MSW1
- 1Carmen and Anne Adams Department of Pediatrics, Wayne State University, Detroit, Michigan
- 2Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina
- Corresponding author: Deborah Ellis, dellis{at}med.wayne.edu
Abstract
OBJECTIVE—The study aim was to determine if multisystemic therapy (MST), an intensive home-based psychotherapy, could reduce hospital admissions for diabetic ketoacidosis (DKA) in youth with poorly controlled type 1 diabetes over 24 months. Potential cost savings from reductions in admissions were also evaluated.
RESEARCH DESIGN AND METHODS—A total of 127 youth were randomly assigned to MST or control groups and also received standard medical care.
RESULTS—Youth who received MST had significantly fewer hospital admissions than control subjects (χ2 = 11.77, 4 d.f., n = 127; P = 0.019). MST-treated youth had significantly fewer admissions versus their baseline rate at 6-month (P = 0.004), 12-month (P = 0.021), 18-month (P = 0.046), and 24-month follow-up (P = 0.034). Cost to provide MST was 6,934 USD per youth; however, substantial cost offsets occurred from reductions in DKA admissions.
CONCLUSIONS—The study demonstrates the value of intensive behavioral interventions for high-risk youth with diabetes for reducing one of the most serious consequences of medication noncompliance.
Footnotes
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Published ahead of print at http://care.diabetesjournals.org on 19 June 2008.
Clinical trial reg. no. NCT00519935, clinicaltrials.gov.
D.A.E., S.N.K., and P.C. are board members of Evidence Based Services, which has a licensing agreement with Multisystemic Therapy Services, LLC, for dissemination of multisystemic therapy treatment technology.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.
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- Accepted June 8, 2008.
- Received October 31, 2007.
- DIABETES CARE
