Margaret Grey, associate dean of the Yale School of Nursing (YSN), has been awarded a $2.4 million federal grant to expand work on a program she developed to help adolescents with diabetes better control their disease and improve their quality of life.
The funding is from the National Institute of Nursing Research (NINR), one of the National Institutes of Health. NINR also funded Grey's original coping skills study, which was completed in 1998.
Several years ago, Grey developed coping skills training for adolescents with diabetes to help them address parental conflict, dietary issues and other factors that can often lead to mismanagement of Type 1 diabetes, often called juvenile diabetes. She based the training on anti-drug and alcohol programs.
The results of the four-year study were striking, says Grey. After six months, youths who had the skills training showed a 42% improvement in metabolic control, an important component in managing 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. If the gains can be maintained, says Grey, these adolescents can expect a 25% reduction in long-term complications, such as blindness and renal failure.
In this next phase of the study, Grey will follow the original participants for an additional four years as
"We want to see if we can make the transitions into and out of adolescence any easier," Grey says. Finally, the study will examine the costs and benefits of intensive therapy and coping skills training.
Intensive therapy is the practice of bringing blood glucose levels as close to normal as possible. For most children and adolescents, that means three or more injections of insulin a day or insulin pump therapy, four to six glucose tests and counting of carbohydrate intake.
Though intensive therapy is now standard with children because research has shown that it reduces long-term problems, it becomes difficult when patients enter adolescence, notes Grey. In fact, prior to her coping skills study, research consistently showed that even attempting intensive therapy with adolescents actually made diabetes worse.
"Teenagers are difficult because they're teenagers," explains Grey. 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, she notes.
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 says.
Grey's co-investigators include YSN Dean Catherine Gilliss; Donna Mahrenholz, associate professor at YSN; Dr. William Tamborlane, professor of pediatrics at the School of Medicine; and William White, associate professor of epidemiology and public health.
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they enter young adulthood to test the long-term benefits of the intervention. She will also offer the coping skills training to pre-adolescents with diabetes and
their parents.
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