Yale Researchers Improve Health and Quality of Life For Youths With Diabetes
New Haven, CT — June 12, 1998A team of Yale researchers has found that teaching coping skills to adolescents with diabetes significantly improves the youths' metabolic control over the disease as well as their overall quality of life. "If the gains made by the adolescents in our study can be maintained, they can expect a 25 percent reduction in long term complications," said Margaret Grey, the principal investigator. After six months, youths who had the skills training showed a 42 percent reduction in metabolic control, which is highly significant in Type 1 diabetes, over peers who had not had the training. They also scored better on quality of life measurements, including reporting fewer worries about their diabetes. The team's report has won the Applied Nursing Research Award, which Grey will accept at the American Nurses Association Council for Nursing Research Conference, on June 26, in San Diego. The research will be published in the journalApplied Nursing Research. At the San Diego conference, Grey will also present the findings of her team in the study funded by the National Institute of Nursing Research. Grey is Associate Dean and Independence Foundation Professor at the Yale School of Nursing and a researcher who has frequently studied the adaptation of children and their families to chronic illness. Her co-author colleagues were Elizabeth Boland and Marianne Davidson, both Lecturers at the Yale School of Nursing, and William Tamborlane, Professor at the Yale School of Medicine and one of the investigators of the landmark Diabetes Control and Complications Trial. The 1993 release of the Diabetes Control Complications Trial results changed the way that Type-1 diabetes (commonly referred to as juvenile diabetes) is treated. The study found that intensive interventions - typically the use of an insulin pump or multiple injections daily, as well as four or more daily blood tests - reduced long term complications. Despite the widespread adoption of this regimen, managing diabetes in adolescents remains difficult. The biological changes of adolescence make even those without diabetes resistant to insulin. These biological issues are compounded by psychosocial ones. As Grey puts it: "Teenagers in particular are difficult because they're teenagers." Factors ranging from resentment of parental control over scheduling injections to fear of appearing strange in front of their friends can prevent adolescents from taking the necessary steps to manage their diabetes, Grey said. For example, drinking alcohol affects blood sugar. But teens often feel peer pressure to drink, and also believe that it is necessary to drink excessively to fit in. "They don't want to be labeled a nerd," she said. Grey and her colleagues hypothesized that training adolescents in such areas as conflict resolution and bargaining techniques would help them do better with their diabetes. They took a sample of 77 adolescents receiving treatment for Type-1 diabetes. The youths were divided into two groups. One received standard treatment. The other received standard treatment plus coping skills training, based on a model originally devised to combat drug and alcohol abuse. The training took place in small group sessions, where adolescents had the opportunity to role play and practice good problem solving skills. Researchers saw adolescents start to use those skills in the management of their diabetes. Grey pointed to the case of a teen who resented his mother "nagging" him about his blood tests. He responded by not doing his blood tests. In Type-1 diabetes, the necessary dosage of insulin can fluctuate dramatically, so frequent blood tests are critical. Through the skills training, the young man was able to think of a way of getting some control over the situation without taking the dangerous step of abandoning blood tests. He has agreed to keep track of his blood tests for several days, after which he'll report them to his mother. He is not doing a perfect job of scheduling his blood tests, but is much improved. "Parents are reluctant to give up managing their kids' diabetes because they don't think the kids are responsible enough to do what they have to do," said Grey. But she added that these adolescents will soon be young adults, living on their own, who will need some experience in maintaining their own health. After six months, the researchers found such dramatic improvement in the group receiving skills training that they felt ethically compelled to offer the training to the control group as well. "This is a relatively inexpensive, brief intervention that has real potential to help adolescents," said Grey.
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