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The effects of weight status on treatment outcomes in a randomized clinical trial of multisystemic therapy for adolescents with type 1 diabetes and chronically poor metabolic control
Author(s) -
Cakan Nedim,
Ellis Deborah A,
Templin Thomas,
Frey Maureen,
NaarKing Sylvie
Publication year - 2007
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/j.1399-5448.2007.00273.x
Subject(s) - overweight , medicine , randomized controlled trial , metabolic control analysis , body mass index , type 2 diabetes , obesity , insulin resistance , diabetes mellitus , regimen , weight loss , physical therapy , pediatrics , insulin , endocrinology
Objective: The purpose of the study was to determine if being overweight attenuated the effect of multisystemic therapy (MST), an intensive, home‐based psychotherapy, on metabolic outcomes among adolescents with type 1 diabetes and chronically poor metabolic control. As overweight is a marker of insulin resistance, it was hypothesized that weight status would limit the impact of behavioral changes in traditional aspects of adherence to the type 1 diabetes regimen on metabolic control. Methods: A randomized controlled trial was conducted with 127 adolescents with type 1 diabetes and hemoglobin A1c (HbA1c) ≥ 8% for the past year. Participants were randomly assigned to MST plus standard care (SC) or SC alone. Data were collected at baseline and 7 months post‐test (i.e., treatment termination). Overweight was defined as body mass index > 85%. Results: Forty‐one percent of the sample was overweight. Intent‐to‐treat analysis showed that adolescents in the MST group had a significant increase in frequency of blood glucose testing (BGT) [F(1,113) = 15.43, p = 0.0001] and a trend to significant improvement in HbA1c [F(1,123) = 2.99, p = 0.086] irrespective of weight. However, HbA1c decreased 0.91% (p = 0.002) for normal weight adolescents in the MST group compared with 0.20% (p = 0.570) for overweight adolescents in the MST group. Discussion: Despite improvements in adherence to BGT, overweight adolescents receiving an intensive behavioral intervention did not have a significant improvement in metabolic control compared with their normal weight peers. Overweight, an accepted marker of insulin resistance and a major public health issue, warrants increased consideration in intervention trials to improve the metabolic control of adolescents with type 1 diabetes.