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A behavioral family intervention to improve adherence and metabolic control in children with IDDM
Bonner, Melanie Jean
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The present study evaluated the effectiveness of a behavioral family intervention on adherence and metabolic control in insulin dependent diabetic children (IODM). Specifically, assumption of regimen responsibilities between the parent and child were manipulated to facilitate regimen adherence. The intervention delivered was a target-specific behavioral contract extended sequentially across four target behaviors (Le., blood glucose testing, insulin injections, diet, and exercise). Regimen components were targeted in a within subjects, multiple baseline design across behaviors to assess the relationship between adherence and metabolic control. Metabolic control was assessed with a measure of glycosylated hemoglobin (e.g., HbA1C.) Five IDDM children (3 female,2 male), who met study criteria (Le., nonadherence to blood glucose testing defined as oS. 2 tests daily and metabolic status outside the optimal range using standard laboratory reference values) were recruited from physician referrals and media announcements. Subjects were between the ages of 10 and 15 years (M = 12.6); four were Caucasian and one was African-American. Mean duration of diabetes upon entry into the study was 4.3 years. Results revealed that four subjects responded to the intervention and three of those four evidenced clinically significant improvements in metabolic control at mid - and/ or post-study. One subject demonstrated only moderate intervention effects and no improvement in metabolic control while another increased adherence, but decrements in metabolic control were noted. These results suggest that adherence may mediate the relationship between family variables and metabolic status. Two additional subjects demonstrating consistently good metabolic were employed to assess the validity of target behaviors. The results were related to various family and diabetes-specific psychosocial indices.
- Masters Theses