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Behavioral intervention improved glycemic control across income levels in youths with type 1 diabetes
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Individualized problem-solving skills aimed at improving diabetes management helped children with type 1 diabetes across income levels improve their HbA1c levels over 2 years, according to research in American Journal of Preventive Medicine.
Tonja Nansel, PhD, of the NIH Eunice Kennedy Shriver National Institute of Child Health and Human Development and colleagues analyzed data from 390 families with children aged 9 to 15 years with type 1 diabetes (49% girls; mean age, 12 years; mean HbA1c, 8.4%; pump use, 34%) at four U.S. pediatric endocrinology clinics over 2 years (data collected between 2006 and 2011). Researchers randomly assigned families to a behavioral intervention (n = 182) or usual care (n = 167), stratified by age, HbA1c and income level. The intervention group participated in the WE-CAN diabetes management program; trained nonprofessionals helped families identify a specific diabetes management problem and work to develop a behavioral plan targeting that issue. Blood samples were taken at each visit to measure HbA1c levels.
Tonja Nansel
Researchers found that the low-income group had a significantly worse baseline HbA1c than middle- or high-income groups and attended fewer clinic visits on average. Overall, however, the treatment group saw a significant change in HbA1c from baseline to follow-up (P = .04). The interaction of treatment and income was not significant (P = .44); those findings were unchanged when baseline HbA1c was included as a covariate.
Researchers also noted a smaller deterioration in glycemic control for the treatment group in low- (0.51 vs. 1.09), middle- (0.42 vs. 0.51) and high-income groups (0.38 vs. 0.71) when compared with controls. In the low- and high-income groups, the deterioration in glycemic control in the intervention group was approximately half that observed in the control group, according to researchers.
“These findings indicate that an individualized applied problem-solving approach, such as that used in the WE-CAN manage diabetes intervention, can be useful in helping families better manage diabetes even in the presence of the added difficulties faced by families of lower income,” Nansel told Endocrine Today. “Research is needed to translate these findings into the provision of health care more broadly — to determine effective methods to integrate behavioral interventions such as this into standard clinical care.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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