Parental motivation could improve diabetes management in high-risk youth

A little motivation for parents could go a long way toward improving young diabetes patients' ability to manage their own care, a Wayne State University researcher believes.

Deborah Ellis, Ph. D, associate professor of pediatrics in WSU's School of Medicine, has received a two-year, $418,000 grant from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health to develop and preliminarily validate a computer-delivered intervention to increase parental motivation to supervise and monitor diabetes management behavior of young adolescents who are beginning to manage their diabetes care by themselves. A companion intervention to increase the youths' own motivation to improve their diabetes care also will be developed as part of the study.

The study, Ellis said, is designed to address poor diabetes-related health outcomes among a particularly high-risk group: urban, African American youth with diabetes. Those disparities can be caused by higher insulin resistance and a greater number of single-parent households among African Americans compared to other groups, she said. Content currently is being developed; actual testing of the intervention is scheduled to start in two to three months.

"Common sense might suggest that parents do need to oversee adolescents' diabetes management," Ellis said, "but there's been a consistent finding in the literature that such supervision doesn't necessarily happen. Research shows that parents tend to back off as their children enter adolescence and let them have more responsibility for care than they are ready to manage.

"We're trying to motivate parents to continue supervising and not simply rely on asking their child if diabetes care was done. The intervention will be delivered by computer, because if you're looking for something you can deliver widely, it's got to be brief and easily replicated, and if you're talking about medical care, it's got to take little time on the part of physicians and other health care providers, because they're very busy."

The study, to be conducted at diabetes clinics run by Dr. Kathleen Moltz, WSU assistant professor of pediatrics, will involve a computer program that uses the motivational interviewing approach. It is adapted from a program developed by grant co-investigator Steven Ondersma, Ph.D, WSU associate professor of psychiatry.

Recent research by Ellis' group has shown that parental supervision and monitoring of adolescents' daily diabetes care is a significant predictor of illness management and metabolic control. No results have been published for clinical trials of interventions that have directly targeted parental monitoring as a means of improving illness management in adolescents with diabetes.

Ellis' study will have three components. In the first, parents and adolescent will receive computer-delivered, motivation-building intervention. Parents will be encouraged to supervise diabetes care, and adolescents will be urged to complete all of their daily diabetes care.

In the second, parents will continue to receive the motivation-building intervention, while adolescents will receive a control intervention consisting of information about diabetes-related topics not directly related to daily diabetes care completion- for example, emergency preparedness for people with diabetes. In the third component, both parents and adolescents will receive a control intervention.

If successful, the intervention will be delivered preventively at diabetes patients' regular doctor visits, Ellis said, adding that stronger interventions still may be needed in some cases. However, her current study could result in a relatively simple way to benefit a large number of patients.

"If you can get an intervention with even a very small effect out there to a huge portion of the population, that's well worth it," Ellis said. "But conversely, you shouldn't fool yourself and think this is what you should do to help adolescents with very poor diabetes management. They may need other types of more intensive intervention."