Figure 1
Literature Search Strategies and Decision Tree.
Table 1
Summary Data for Selected Indicators of Clinical Utility (n = 50 studies).
| FEATURE/INDICATOR | FREQUENCY | PERCENT |
|---|---|---|
| Problem Base: | ||
| Reference to disease burden | 37 | 74% |
| Context Placement: | ||
| Reference to systematic review | 28 | 56% |
| Use of theory | 26 | 52% |
| Information Gain: | ||
| Significant reduction in HbA1c (N = 41) | 15 | 30% |
| Adequate power reported (>.80) | 21 | 42% |
| RCT design | 38 | 76% |
| Cited > 50 times | 14 | 28% |
| Transparency: | ||
| Open-access publication | 19 | 38% |
| Open access to participant-level data | 0 | 0% |
| Pragmatism: | ||
| Multi-site recruitment (≥2 sites) | 27 | 54% |
| Sociodemographic information reported | 36 | 72% |
| Intervention costs reported | 5 | 10% |
| Patient-Centeredness: | ||
| Medical and psychosocial outcomes | 36 | 72% |
| Participant satisfaction assessed | 21 | 42% |
Table 2
Characteristics of the Identified Studies.
| # | CITATION | SAMPLE SIZE, N (I/C) | AGE RANGE | STUDY DESIGN | INTERVENTION(S) | FREQUENCY/DURATION | DELIVERY METHOD | FACILITATOR/SETTING | MAIN RESULTS: BIOMEDICAL/HEALTH BEHAVIOUR | MAIN RESULTS: PSYCHOSOCIAL OUTCOMES |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Aguilar et al. (2011) | 37 | 9–16 years | Prospective cohort | Education intervention using One Touch UltraSmart | 1 session/month over 7 months | Technology | Nurse or physician/medical | Significant average reduction of HbA1c. Significant improvement in dietary habits. | Not assessed. |
| 2 | Channon et al. (2007) | 66 (38/28) | 14–17 years | RCT | Motivational Interviewing (MI) | 12 months | Behaviour change (individual) | Health psychologist/ home or community | At 12 months, mean HbA1c in the MI group was significantly lower than in the control group after adjusting for baseline values. Difference in HbA1c was maintained at 24 months. | At 12 months, the MI group showed a higher degree of positive well-being & improved quality of life (i.e., higher life satisfaction, lower life worry, less anxiety, and more positive well-being. There were also differences in personal models of illness (e.g., the MI group perceived their diabetes to be more serious and placed greater importance on controlling it). |
| 3 | Christie et al. (2014) | 362 (181/!81) | 8–16 years | RCT | Child and Adolescent Structured Competencies Approach to Diabetes Education (CASCADE): An intensive competency-driven, motivational, psychoeducational program involving patients and families | 1 module/month for 4 months | Family -focused | Pediatric specialist nurse/medical | The intervention did not improve HbA1c at 12 months or 24 months. | Intervention group parents at 12 months and adolescents at 24 months had higher scores on diabetes family responsibility questionnaire. Adolescents in the intervention group reported reduced happiness with body weight at 12 months. |
| 4 | Coates et al. (2013) | 135 (70/65) | 13–19 years | RCT | Carbohydrate, Insulin, Collaborative Education (CHOICE) | Four 3-hour weekly sessions over 1 month | Behaviour change (Individual) | Diabetes specialist nurse and Dietician/community | No significant difference between groups in HbA1c at 12 months; however, there was a significant difference at 24 months. No difference in BMI or in reported hyper or hypoglycemia episodes. | Not assessed. |
| 5 | de Wit et al. (2008) | 91 (46/45) | 13–17 years | RCT | Monitoring and discussing health-related quality of life (HRQoL) with adolescent patients | 3 regularly scheduled visits in 12 months | Behaviour change (individual) | Pediatrician/medical | No significant differences between groups over time for HbA1c levels. | Means scores on psychosocial health, behaviour, mental health and family activities improved in the intervention group, except for adolescents with the highest HbA1c. Adolescents in the intervention groups reported higher self-esteem at follow-up regardless of HbA1c, and were more satisfied with care than control subjects. |
| 6 | de Wit et al (2010) | 81 (41/40) | 13–17 years | RCT | Monitoring and discussing health-related quality of life (HRQoL) with adolescent patients | 3 regularly scheduled visits in 12 months *1 year follow-up study | Behaviour change (individual) | Pediatrician/medical | 12 months post-intervention, HbA1c values had increased significantly. | Mean scores on behaviour, mental health and self-esteem had significantly decreased, whereas family activities subscale remained stable. Adolescents were also less satisfied with their care. |
| 7 | Ellis et al. (2005) | 127 (64/63) | 10–17 years | RCT | Multi-Systemic Therapy (MST): Intensive, family-centered and community-based intervention | 6 months | Family-focused | Family therapist/home | Participation in MST improved HbA1c through regimen adherence (mediator). | MST was associated with significant reductions in diabetes-related stress. |
| 8 | Galler et al. (2020) | 31,861 (12,326/19,535) | 11–17 years | Record review | Comparison of German adolescents receiving any type of psychological support and those without psychological support | 2009–2017 | Short-term and continuous care psychology or psychiatry support (individual) | Psyshcologist/variable | Those receiving psychological support were significantly worse in HbA1c, BMI, and hospital admission rate. Direction of causality not investigated. | Worse metabolic outcomes associated with need for psychological care and receipt of psychiatric diagnosis. |
| 9 | Garcia-Perez et al. (2010) | 55 (34/21) | 11–18 years | Prospective cohort | Psycho-educative intervention implemented in a summer camp consisting of | 8 days | Behaviour change (group) | Diabetes educator and psychologist/summer camp | No significant changes in HbA1c, BMI, medical visits or hospital admission from pre- to post-intervention. | No significant changes in diabetes knowledge or anxiety after receiving the intervention. |
| medical, educational, and psychosocial components (e.g., interactive seminars about diet, hygiene, recognition and management of hypo- and hyperglycemia, as well as relax seminars and games) | ||||||||||
| 10 | Graue (2005) | 101 (55/46) | 11–17 years | RCT | Structured educational and counselling program combining group visits and individual computer-assisted consultations | 15 months | Technology | Physician, diabetes nurse specialist, dietician, clinical psychologist & social worker/medical | No significant effect on mean HbA1c. | Significant age-by-group interactions for diabetes-related impact, worries, mental health and general behaviours, implying that the intervention was effective for adolescents above 13/14 years of age |
| 11 | Grey et al. (2013) | 320 (167/153) | 11–14 years | RCT | TEENCOPE: Internet-based Coping Skills Training (CST) Managing diabetes: Internet-based diabetes education and problem-solving program (comparison group) | 1 session per week over 5 weeks | Technology | Technology/home | At 12 months, there were no significant differences between intervention groups in terms of HbA1c. At 18 months, significantly lower HbA1c was noted for youth completing both groups versus just one intervention. | There were no significant differences between intervention groups in relation to QoL at 12 months. Youth in both groups had stable QoL (i.e., no change from pre- to post-intervention). At 18 months, higher QOL, social acceptance and self-efficacy, as well as lower perceived stress and diabetes family conflict for youth completing both groups. |
| 12 | Guo (2020) | 100 (50/50) | 12–20 years | RCT | Coping skills training contained sessions on goal setting, communication, social | Six 90-minute sessions presented in a 3-day camp setting | Behaviour change (group) | Diabetes educators/summer camp | No change in HbA1c, perceived stress, coping style, quality of life. | Feasible and well accepted. However, the program had no effect on any of the dependent variables. |
| problem-solving, conflict management, stress management, and positive self-talk | ||||||||||
| 13 | Hilliard et al. (2020) | 80 (55/24) | 12–17 years | RCT | DoingWell app designed to support parents and reinforce positive teen’s diabetes-related behaviours | Mean of 106 days using the app at least one time per day for 80% of days | Family-focused | Technology/home | No change in HbA1c, resilience, family conflict, self-management, quality of life, or self-case inventory. | Feasible and well accepted. However, the program had no effect on any of the dependent variables. |
| 14 | Holmes et al. (2014) | 226 families (137/89) | 11–14 years | RCT | Coping program: Individualized, intensive family teamwork coping skills training Education program: Psychologically supportive education program to maintain parental involvement and disease care throughout early adolescence | 4 quarterly appointments over 1 year | Family-focused | University-affiliated interventionist/medical | Rate of change in HbA1c over time was significantly better for the Education versus Usual Care (UC) group, and for the Education versus Coping group (i.e., glycemic control improved in the Education group over time compared with the other two groups). HbA1c of the Coping and UC groups did not differ from one another. Education group improved in diabetes adherence across all follow-ups and improved more over time relative to the Coping group. The Coping group demonstrated sustained diabetes adherence. | Both groups showed lower levels of parental monitoring over time, although the Education group tended to have more parental monitoring than the Coping group over time. Both groups had positive parental expectations about involvement. No significant changes in diabetes-related and general family conflict, or self-efficacy. |
| 15 | Husted et al. (2014) | 71 (37/34) | 13–18 years | RCT | Guided Self-Determination- Youth (GSD-Y): A life skills approach to facilitate empowerment in the patient-provider relationship, adapted for adolescents and their parents | 8 sessions over 8–12 months | Behaviour change (individual) | Physicians, nurses, dietician/medical | No significant effect on HbA1c. | GSD-Y significantly reduced the motivation for diabetes self-management after adjusting for the baseline value. |
| 16 | Iafusco et al. (2011) | 396 (193/203) | 10–18 years | Prospective cohort | Chat line supervised and moderated by a physician; took place once a week. The topic of each session was chosen and voted on by all participants at the beginning of the chat and might concern diabetes management, as well as anxiety about the future and interpersonal and social relationships (sexual life, travels, etc.) | 1 chat per week over 2 years | Technology | Physician/home | Significant decrease in HbA1c in patients who participated in chat session compared with the controls. No difference was observed in HbA1c between the two groups. | Significant improvement diabetes-related QoL in patients who participated in chat sessions. |
| 17 | Jaser, Patel et al. (2014) | 39 (20/19) | 13–17 years | Pilot RCT | Check-It!: A positive psychology intervention designed to increase positive affect (PA) through gratitude, self-affirmation, small gifts, and parental affirmations Attentional control (Education) condition: Mailed diabetes educational materials | Every 2 weeks over an 8-week period | Behaviour change (individual) | Program facilitator and parent/home | No main effects for treatment were observed at 6-month follow-up. | A significant association between adolescents’ level of positive affect and measures of adherence (including self-report and metered blood glucose monitoring) was found. |
| 18 | Jaser et al. (2014) | 320 (167/153) | 11–14 years | RCT | TEENCOPE: Internet-based CST Managing Diabetes: Internet based diabetes education and problem-solving program | 1 session per week over 5 weeks | Technology | Technology/home | No significant effects of either intervention on HbA1c. No significant between-group intervention effects. | Both groups showed significant improvements in QOL over time. No significant between-group intervention effects. Self-efficacy mediated the effects on quality of life in both interventions. |
| 19 | Kassai et al. (2015) | 77 (39/38) | 12–17 years | RCT | Nurse counselling intervention | 1 pediatrician visit per month, 1 nurse visit and phone calls over 3 months | Behaviour change (individual) | Physician and nurse/medical | The evolution of A1C over the follow-up period was not significantly influenced by the nurse intervention. | Participants’ acceptance of the disease did not change over time. |
| 20 | Katz (2014) | 153 (50/52/51) | 8–16 years | RCT | Care ambassador (CA+) and family-based psychoeducation | 30-minute quarterly sessions over 2 years | Family-focused | Research assistant/medical and home | No differences in HbA1c across treatment groups. Among youth with suboptimal baseline A1c, more youth in the CA+ psychoeducation group maintained or improved their HbA1c. | Among youth with suboptimal baseline A1c, significant increase in parent involvement in the CA+ psychoeducation than in the other groups (i.e., standard care or CA alone) without negative impact on youth QOL or increased diabetes-specific family conflict. |
| 21 | Kichler (2013) | 30 (15/15) | 13–17 years | RCT | K.I.D.S project: A synthesis of treatment strategies from diabetes education, behaviour therapy, and family therapy; separate group sessions conducted for adolescents and parents | Six 30–45-minute sessions | Family-focused | Psychologist/mental health clinic | No statistically significant changes in HbA1c and healthcare utilization from 6 months prior to 6 months post-treatment. | At 4 months post-treatment, parents and youth reported increased parent responsibility and parents reported improved youth diabetes-specific quality of life. |
| 22 | Lawson (2005) | 46 (23/23) | 13–17 years | RCT | Regular standardized telephone contact with a diabetes nurse educator, including a review of blood glucose results and insulin dose adjustments, problem-solving and diabetes education. | Weekly telephone contact over 6 months | Technology | Diabetes nurse educator/medical – home | Intervention had no immediate effect. However, 6 months post-treatment, HbA1c levels decreased in 6 out of 21 individuals of the study group and 0/18 of the control group, while Hba1c increased in 4/21 study subjects and 8/18 control subjects. | Intervention had no effect on OoL immediately following or 6 months post-intervention. |
| 23 | Maranda (2015) | 28 (16/12) | 10–17 years | Pilot RCT | Structured care of a betta splendens fish: Participants were instructed to check glucose readings and review glucose logs at times corresponding to the care of the betta fish | 3 months | Behaviour change (individual) | Researcher/home | After 3 months, participants in the intervention group showed a significant decrease in HbA1c level compared to controls who had an increase. No significant effects on self-management. | No significant effects for Pediatric QoL. Younger adolescents (10–13 years) demonstrated a significantly greater response to the intervention than older adolescents (14–17 years). |
| 24 | Monaghan et al. (2015) | 30 families | 11–15 years | Prospective Cohort | Checking In: A physician delivered intervention to increase parent-adolescent communication | 12 weeks | Family-focused | Physician/medical | Overall, no significant change in indicators of glycemic control (HbA1c, blood glucose monitoring, mean blood glucose) from pre- to post- intervention. However, participants who reported adhering to the intervention (n = 15) demonstrated a significant increase in BG-monitoring frequency. | Parent-reported conflict surrounding diabetes management significantly decreased from pre- to post-intervention. |
| 25 | Mulvaney (2012) | 46 (23/23) | 13–17 years | Prospective cohort | SuperEgo: Text messaging intervention providing a combination of guidance and choice for users via individually tailored messages | 3 months | Technology | Technology/home or community | Mean HbA1c remained unchanged in the intervention group, but significantly increased in the control group. | Not assessed. |
| 26 | Murphy et al. (2012) | 305 (158/147) | 11–16 years | RCT | Families and Adolescents Communication and Teamwork Study (FACTS): A family-centred group education program | 1 session per month over 6 months. | Family-focused | Health professionals/medical | 12 months post-intervention, there was no significant difference in HbA1c in either group and no between group differences over time. | Adolescents perceived no changes in parental input at 12 months. |
| 27 | Murphy et al. (2007) | 78 children and adolescents (40/38) | 6–11 or 12–16 years | RCT | Families and Adolescents Communication and Teamwork Study (FACTS): A family-centred group education program | 4 educational sessions over 1 year | Family-focused | Health professionals/medical | No significant difference in HbA1c between participants randomized to the immediate or delayed program (control group). For youth who attended ≥ 2, HbA1c fell by 0.29% compared with an increase in non-attenders. | No significant difference between groups in parental responsibility. However, at 12-month follow-up, families who attended two or more sessions reported a significant increase in parental involvement. |
| 28 | Nansel et al., 2012 | 390 families (201/189) | 9–15 years | RCT | WE-CAN manage diabetes: A clinic-integrated behavioural intervention designed to help families improve diabetes management by facilitating problem-solving skills, communication skills, and appropriate responsibility sharing | 24 months | Family-focused | Trained non-professional/medical | Significant overall intervention effect on change in Hba1c from baseline to 24-month interval. A significant intervention-by-age interaction; among participants aged 12 to 14, a significant effect on glycemic control was observed, but there was no effect among those aged 9 to 11. No intervention effect on child or parent report of adherence. | Not assessed. |
| 29 | Nansel et al. (2015) | 136 (66/70) | 8–16 years | RCT | Family-based behavioural intervention integrating motivational interviewing, active learning, and applied problem-solving to improve dietary intake of youth with diabetes | 12 months | Family-focused | Trained non-professional/medical | No significant difference between groups in HbA1c across the study duration. There was a positive intervention effect across the study duration for diet quality. | Not assessed. |
| 30 | Nansel, Thomas, & Liu (2015) | 390 families (201/189) | 9–15 years | RCT | WE-CAN manage diabetes: A clinic-integrated behavioural intervention designed to help families improve diabetes management by facilitating problem-solving skills, communication skills, and appropriate responsibility sharing | 21 months | Family-focused | Trained non-professional/medical | Significant overall effect of treatment on change in HbA1c from baseline to follow-up. Baseline HbA1c was significantly poorer in the low-income group. Interaction for treatment-by-income was not significant. | Not assessed. |
| 31 | Nansel et al. (2007) | 81 (40/41) | 11–16 years | RCT | Diabetes “Personal Trainer” intervention designed to enhance motivation and capability for diabetes management | 6 sessions over 2 months | Behaviour change (individual) | Trained non-professional/home or community | At both short-term and 1 year follow-up, there was a significant intervention-by-age interaction, indicating a greater effect on HbA1c among older than younger youth; no treatment group differences among pre-/early adolescents (11–13 years), but a significant difference among middle adolescents (14–16 years). | No treatment group differences in parent or youth report of adherence. |
| 32 | Nansel et al. (2009) | 81 (40/41) | 11–16 years | RCT | Diabetes “Personal Trainer” intervention –designed to enhance motivation and capability for diabetes management | 6 sessions over 2 months | Behaviour change (individual) | Trained non-professional/home or community | Significant intervention effects on HbA1c among middle adolescents maintained at 1-year follow-up. | Not assessed. |
| 33 | Newton & Ashley (2013) | 59 (25/25) | 13–18 years | RCT | Diabetes Teen Talk: Web-based intervention that provides teens with opportunities to discuss solutions to psychosocial problems that make treatment compliance difficult | 7 weeks | Technology | Technology with moderator/home | Not assessed. | Marginally significant difference between groups on combined outcome measures: Diabetes-related QoL, self-efficacy and outcome expectations. Effect of the treatment condition was predominantly carried by a significant difference between treatment conditions on the Positive Outcomes Expectations (with those in the control group reported higher outcome expectations). |
| 34 | Newton et al. (2009) | 78 (38/40) | 11–18 years | RCT | Use of an open pedometer & motivational text messages reminding users to wear the pedometer and be active | 12 weeks | Technology | Home and community | No significant differences in secondary measures: HbA1c, blood pressure, BMI. At 12 weeks, there was no significant difference in change in physical activity measures between the groups. | No significant differences in QoL. |
| 35 | Nicholas et al. (2012) | 31 (15/16) | 12–17 years | RCT | Online education and support website intervention combining three key components: diabetes-based information, interactive learning activities, and discussion topics relevant to adolescents | 8 weeks | Technology | Technology with moderator/home and community | Not assessed. | Pre-post intervention gains approaching significance (at .05 level) in perceived social support (i.e., awareness of relationships with others outside of participants’ family). |
| 36 | Noyes et al. (2020) | 308 (190/103) with significant attrition | 6–18 years | RCT | Standardized self-management kits | 6 months | Technology | Family with diabetes educator support/medical | Standardised kits showed no evidence of benefit, inhibited diabetes self-management and increased worry. | Information-only kits resulted in no change. Many participants were unwilling to pay the cost of the kits. |
| 37 | Price et al. (2016) | 396 (199/197) | 11–16 years | RCT | KICk–OFF: A group education course designed to meet the learning styles of adolescents. It employs interactive and practical learning activities focusing on carbohydrate counting and insulin adjustment in everyday life | 5 days | Behaviour change (group) | Nurse and dietician/community | HbA1c was no different at 24 months. | Significantly improved total QoL scores within 6 months. |
| 38 | Ramírez-Mendoza et al. (2020) | 121 | 8 –13 years | Prospective cohort | PANDA: interdisciplinary care plan to empower children in self-management | 6 months | Behavior change (group) | Interdisciplinary care plan includes three integrative areas: social work, pediatric nursing and endocrinology | Improvements in HbA1c and glycemic variability. | The program resulted in improvements over time. |
| 39 | Serlachius et al. (2016) | 147 (73/74) | 13–16 years | RCT | Best of Coping (BOC) program: A cognitive behaviour-therapy-based program to improve glycemic control and psychosocial well-being | Five 2-hour long weekly sessions | Behaviour change (group) | Health psychologist/hospital | No difference in HbA1c between groups at follow-up. | Psychosocial well-being improved in the intervention group compared to the control group. |
| 40 | Spiegel et al. (2012) | 66 (33/33) | 12–18 years | RCT | Nutrition education intervention, which involved attending an educational class offered by a registered dietician/certified diabetes educator and keeping 3-day food records | One 90-minute class, and the completion of 2 sets of 3-day food records | Behaviour change (group) | Dietician and diabetes educator/medical | At 3-month follow-up, the overall intervention effect was not statistically significant for change in HbA1c or carbohydrate counting accuracy. | Not assessed. |
| 41 | Verbeek et al.(2011) | 25 | 11–17 years | Prospective cohort | Psycho-educational intervention focusing on importance of adequate BG monitoring, difficulties to achieving good glycemic control, importance of good diet, and the psychological aspects of coping with diabetes | Four 1.5-hour sessions over 3 months | Behaviour change (group) | Diabetes nurse/medical | HbA1c levels decreased by 0.65 % after 9-month follow-up. A subgroup of 15 patients showed a clinical significant HbA1c reduction at 9-month follow-up with a mean reduction of 1.6 %. | Not assessed. |
| 42 | Viklund et al.(2007) | 32 (18/14) | 12–17 years | RCT | Empowerment education program involving group sessions | Six 2-hour sessions over approximately 6 weeks | Behaviour change (group) | HbA1c was similar in the intervention and control group 6 months after the intervention. HbA1c significantly increased among adolescents in the intervention at 6- and 12-month follow-up but returned to baseline levels 18 months after the program. | At 6-month follow-up, there was no difference between the groups in terms of empowerment. | |
| 43 | Von Sengbusch et al. (2005) | 104 youth & 95 parents | 8–16 years | Prospective cohort | Provision of a mobile diabetes education and care team to families who have limited access to specialized diabetes care in rural areas | 1 or 2 educational sessions/week over 2 years | Family-focused | Physician and nurse/medical | HbA1c values significantly improved and rate of hospitalization fell, from baseline to follow-up. | Youth reported significantly better diabetes-specific quality of life and higher self-esteem after the intervention. Theoretical diabetes knowledge increased at both short- and long-term follow-up. |
| 44 | Waller et al. (2008) | 48 | 11–16 years | Prospective cohort | Kids in Control of Food (KICk-OFF): A modular educational program providing information on carbohydrate counting and insulin adjustment | 6 courses delivered over 5 school days | Behaviour change (group) | Pediatric diabetes nurse and dietician/school | No changes in HbA1c, BMI, or episodes of hypoglycemia. | Youths and parents reported significantly improved QoL (generic and diabetes-specific) as well as satisfaction with treatment at 6-month follow-up. Youth reported improved self-efficacy, and both youth and their parents reported greater child responsibility for a range of management tasks. No significant changes in either youth- or parent-reported family conflict. |
| 45 | Wang et al. (2010) | 43 (21/22) | 12–18 years | RCT | Motivational Interviewing (MI) in Education Structured Diabetes Education (SDE) | 2–3 sessions over a 3- to 4-month period | Behaviour change (group) | Diabetes educator/medical | At 6-month follow-up, youth participating in SDE had significantly lower mean HbA1c than youths in the MI group. | No between-group differences on any psychosocial measures (i.e., QoL, stress, self-efficacy, self-perception, or family conflict). |
| 46 | Whittemore et al. (2012) | 320 (167/153) | 11–14 years | RCT | TEENCOPE: Internet-based CST Managing Diabetes: Internet-based diabetes education and problem-solving program | 6 months | Technology | Technology/home and community | HbA1c significantly increased in the Managing Diabetes group. No significant between-group treatment effects 6 months post-intervention on HbA1c. | At 6 months, no significant between-group treatment effects on QoL. |
| 47 | Whittemore et al. (2016) | 124 (64/60) | 11–14 years | RCT | Teens.Connect: Combines Managing Diabetes & TEENCOPE – an interactive Internet program aimed at increasing teens’ coping and social self-efficacy Planet D + discussion board: An open-access diabetes website for youth providing age- appropriate diabetes education | 1 session per week over 5 weeks | Technology | Technology/home and community | After 6 months, there were no significant differences in HbA1c between groups. | No significant between-group differences in QoL or secondary outcomes (i.e., self-efficacy, self-care, perceived stress, depression) at 6 months. Teens in the Teens.Connect group reported lower perceived stress over time (p < 0.01). |
| 48 | Wysocki et al. (2006) | 104 families (36/36/32) | 11–16 years | RCT | Behavioural Family Systems Therapy for Diabetes (BFST-D): A modified BFST intervention to achieve greater impact on diabetes-related family conflict, treatment adherence, and metabolic control Multifamily educational support (ES) | 12 sessions over 6 months | Family-focused | Psychologist or social worker/medical | BFST-D and ES significantly improved HbA1c compared to standard care among those with poorer metabolic control at baseline. | BFST-D significantly improved family conflict and adherence compared to ES and standard care, especially among those with poorer metabolic control. |
| 49 | Wysocki et al. (2007) | 104 families (36/36/32) | 11–16 years | RCT | Behavioural Family Systems Therapy for Diabetes (BFST-D) Multifamily educational support (ES) | 12 sessions over 6 months | Family-focused | Psychologist or social worker/medical | BFST-D was superior to ES and standard care in the effects on HbA1c. A significantly higher percentage of BFST-D youth achieved moderate or greater improvement in treatment adherence compared with the standard care group at each follow-up and the ES group at 6 and 18 months. | There was a consistent reduction in family conflict and improved adherence, favoring BFST-D over ES and SC. For these outcomes, there were significant main effects for groups, but the group-by-time interaction effects were not significant. |
| 50 | Wysocki et al. (2008) | 104 families (36/36/32) | 11–16 years | RCT | Behavioural Family Systems Therapy for Diabetes (BFST-D) Multifamily educational support (ES) | 12 sessions over 6 months | Family-focused | Psychologist or social worker/medical | Improvement in adolescents’ communication was significantly associated with improvements in HbA1c scores at 6 months, as well as improved adherence at 6 and 12 months. | BFST-D improved individual communication of adolescents and mothers, but not fathers. BFST-D significantly improved quality of family interaction compared to ES and standard care. Changes in family communication were associated with changes in family conflict. |