Testing MST to Improve Adherence Among Youth With Chronic Poor Metabolic Control
Testing MST to Improve Adherence Among Youth With Chronic Poor Metabolic Control
The protocol is a randomized clinical trial providing Multisystemic Therapy (MST), an
 intensive home-based family psychotherapy intervention, to a group of urban adolescents with
 poorly controlled Type 1 diabetes and their families.
Substantial data exists to demonstrate that improving metabolic control in persons with Type
 1 diabetes mellitus (T1DM) can delay the onset of diabetes complications and reverse some
 existing complications as well. Unfortunately, those adolescents with T1DM who are at highest
 risk for diabetes complications are often the most resistant to hospital based care and
 traditional education/ supportive interventions. They are also faced with multiple barriers
 to improved metabolic control, which may include lack of knowledge about diabetes, family
 disorganization and disengagement, high levels of stress and an unhealthy lifestyle.
 Multisystemic Therapy (MST), a flexible and home-based therapeutic intervention originally
 designed for use with mental health populations, seems to be a promising approach to
 providing diabetic adolescents with the ability to engage in consistent and attentive illness
 management.

 The study recruited a sample of 127 adolescents in poor metabolic control and randomly
 assigned them to either the treatment intervention, MST plus standard medical care, or
 standard medical care alone. Families randomized to MST received intensive, home-based family
 therapy for approximately six months. Families completed data collection at baseline and then
 again at 7, 12 18 and 24 months after study entry.
Inclusion Criteria:

 -  a current hemoglobin A1c(HbA1c) of >8.0%

 -  an average HbA1c of >8.0% during the past year

 -  diagnosed with Type 1 diabetes for at least one year

 -  reside in the metro Detroit tri-county area

 Exclusion Criteria:

 -  severe mental impairment/thought disorder

 -  non-English speaking patient/parent

 -  co-morbid major medical condition such as cystic fibrosis