MST for Adolescents with Poorly Controlled Type I Diabetes: Reduced DKA Admissions and Related Costs over 24 Months

Deborah Ellis; Sylvie Naar-King; Thomas Templin; Maureen Frey; Phillippe Cunningham; Ashli Sheidow; Nedim Cakan; April Idalski

doi:10.2337/dc07-2094

MST for Adolescents with Poorly Controlled Type I Diabetes: Reduced DKA Admissions and Related Costs over 24 Months

Deborah Ellis, Ph.D (dellis{at}med.wayne.edu)¹,
Sylvie Naar-King, Ph.D¹,
Thomas Templin, Ph.D.²,
Maureen Frey¹,
Phillippe Cunningham, Ph.D.³,
Ashli Sheidow, Ph.D.³,
Nedim Cakan, M.D.¹ and
April Idalski¹

¹ Carman and Anne Adams Dept. of Pediatrics, Wayne State University
² Carman and Anne Adams Department of Pediatrics, Wayne State University
³ Department of Psychiatry, Medical University of South Carolina

Abstract

Objective: The study aim was to determine if Multisystemic Therapy (MST), an intensive home-based psychotherapy, could reduce 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: 127 youth were randomly assigned to MST or control plus standard medical care.

Results: MST youth had significantly fewer admissions than controls [X² (4, N=127) =11.77, P=.019]. MST youth had significantly fewer admissions versus their baseline rate at 6 month (P=.004), 12 month (P=.021), 18 month (P =.046), and 24 month follow-up (P = .034). Cost to provide MST was $6,934 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 non-compliance.