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A multicenter randomized controlled trial of motivational interviewing in teenagers with diabetes

Channon, Susan Jane, Huws-Thomas, Michelle Victoria, Rollnick, Stephen, Hood, Kerenza, Cannings-John, Rebecca Louise, Rogers, Carol and Gregory, John Welbourn 2007. A multicenter randomized controlled trial of motivational interviewing in teenagers with diabetes. Diabetes Care 30 (6) , pp. 1390-1395. 10.2337/dc06-2260

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Abstract

OBJECTIVE—We sought to examine the efficacy of motivational interviewing with teenagers aged 14–17 years with type 1 diabetes. RESEARCH DESIGN AND METHODS—In a randomized controlled trial analyzed by intention to treat, 66 teenagers with type 1 diabetes attending diabetes clinics in South Wales, U.K., were randomly assigned to the intervention group (38) and control group (28). Teenagers in the intervention group received motivational interviewing, and the control group received support visits. All participants received individual sessions over 12 months. The main outcome measures assessed at baseline, 6, 12, and 24 months were serum A1C and psychosocial self-report questionnaires including quality of life and well-being measures. RESULTS—At 12 months, 60 patients had complete data. At the end of the intervention (12 months), the mean A1C in the motivational interviewing group was significantly lower than in the control group (P = 0.04), after adjusting for baseline values. At 24 months (when n = 47), this difference in A1C was maintained (P = 0.003). There were differences in psychosocial variables at 12 months, with the motivational interviewing group indicating more positive well-being, improved quality of life, and differences in their personal models of illness (all P < 0.01). Some of these differences were maintained at 24 months. CONCLUSIONS—Motivational interviewing can be an effective method of facilitating behavioral changes in teenagers with type 1 diabetes with subsequent improvement in their glycemic control. Type 1 diabetes is the third most common chronic illness in teenagers (1). It imposes physical and emotional burdens on young people and their families (1) and can have a profound effect on quality of life (2). The beneficial effects of favorable glycemic control in the prevention of long-term complications are well documented (3). However, recognition of the impact of psychosocial factors on self-care during adolescence has led to a focus on psychosocial interventions to improve outcomes. A review of educational and psychosocial interventions for adolescents with type 1 diabetes (4) concluded that there was a need for more well-designed trials of such interventions, particularly in the U.K. health care context. Motivational interviewing, a counseling approach to facilitate behavioral change (5), has been demonstrated as effective in adults in some health care settings (6,7), and there is preliminary evidence of its effectiveness in improving glycemic control and psychological well-being in teenagers with type 1 diabetes in short-term, uncontrolled trials (8,9). The multicenter randomized controlled trial reported here was developed to replicate and extend the findings of the pilot study (8), employing a fully powered design and an evaluation of longer-term outcomes.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: American Diabetes Association
ISSN: 0149-5992
Last Modified: 15 Dec 2017 08:34
URI: http://orca.cf.ac.uk/id/eprint/796

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