Family-based diabetes self-management leads to better health

May 1 2004

In a pilot study, researchers at the University of Michigan Health System found a family-based self-management intervention aimed at low income adolescents with Type 1 diabetes led to better health and functioning in the short term. Results of the study will be presented May 1 at the Pediatric Academic Societies’ annual meeting in San Francisco.

“Almost all kids can struggle with their diabetes control when they move into adolescence. It’s so hard when you have a chronic illness and are on a stricter regimen for eating than your friends. Parents expect kids to take on more responsibility for their diabetes care. At the same time, kids tend to be on their own more and the diabetes care can become overwhelming,” says Lisa Opipari-Arrigan, Ph.D., clinical assistant professor of Pediatrics at the U-M Medical School.

“With kids who are economically disadvantaged, there can be a lot more stressors involved,” Opipari-Arrigan adds. “The child’s diabetes care may need to be secondary to the parents being at work, maintaining shelter or basic necessities. Even though the parents want to be involved, it might not be possible.”

The study looked at 29 children ages 10-14 who were on Medicaid or other state-assisted insurance. The researchers developed a diabetes self-management program based on proven techniques. Families met in groups of eight to 10 for six weeks, getting diabetes education, information on adolescent development and tips on working as a family to manage the child’s diabetes. Families practiced hands-on techniques for communicating, problem solving and setting goals.

Each child was tested both before and after the intervention program for blood glucose control and physical functioning. Parents were also asked to assess family life issues.

At the end of the six-week program, blood glucose measures remained stable and the kids reported improved physical functioning. The blood glucose measure, hemoglobin A1C, is typically measured every three months, so this period would have been too brief to show improvement.

But the intervention program helped the kids eat better and exercise more, which likely explains the immediate improvements in how the kids feel. Opipari-Arrigan expects that to translate into long-term improvements in HbA1C levels.

The parents reported that their children were doing better at diabetes management, and both groups said they were working together more as families.

“Parents and kids talking about diabetes and supporting each other is important. Diabetes can be an overwhelming chronic illness to manage because there’s so much that needs to be done every day,” Opipari-Arrigan says.

The study authors will continue to follow the families through September. Every three months, the families return to the clinic for a chance to meet up with each other and refresh the information they’ve learned. For many families, this is the first time they’ve interacted with other children or parents of children with diabetes.

The study was funded by the Michigan Department of Community Health. In addition to Opipari-Arrigan, study authors were research fellow Jessica Kichler, research fellow Emily Fredericks, nurse practitioner Nugget Burkhart, clinical care coordinator Linda Dale, research assistant Sally Eder, research fellow Alan Silverman, clinical professor of Pediatric Critical Care Susan L. Bratton, M .D., MPH, and professor of Pediatric Endocrinology Carol Foster, M.D., all from the UMHS Department of Pediatrics.

Diabetes is a disorder in which the body cannot convert foods properly into the energy needed for daily activities. Diabetes tends to get passed on genetically but factors other than heredity are responsible as well. There are two main types of diabetes. Type I, or insulin-dependent, is the more severe for of the disease. Type II, or adult onset, is the more common form and accounts for more than 85% of all cases. Diabetes cannot be cured, but it can be controlled. Control requires carefully regulating one's diet, regular exercise, and, if necessary, insulin.