Intervention with motivational Interviewing and cognitive behavioral elements in DMT1-adolescents with suboptimal metabolic control

Aim: To investigate the effect of motivational interviewing (MI) and cognitive behavioral elements (CBT) on metabolic control and diabetes complications in adolescents with T1DM in a multicenter study.

Methods: adolescents with T1DM (age = 13 – 20yrs.) with suboptimal control (HbA1C > 8% at least once during the past year) were randomized in 2 groups to examine the effectiveness of an e-mail-supported 6 months intervention of MI and CBT (IV, n = 40) compared to “treatment as usual” (CO, n = 35) at 6 months- at one- and two-year follow-up.

Results: Baseline characteristics: IV vs. CO-groups: age: 15.84 ± 1.55 and 15.80 ± 2.04 years; duration of diabetes: 7.02 ± 3.15 and 7.57 ± 3.60yrs., sex: 40% and 45, 7% male and HbA1c: 9.95 ± 0.26 and 9.24 ± 0.28%. After the 6-months intervention we found an HbA1c-improvement in the IV-group: 9.74 ± 1.75, CO: 9.45 ± 1.69%, but not statistically significant. Similar results were found for the 1st and 2nd year evaluation. Within the IV-group we found older patients (16 – 20yr) from the same treatment arm to improve significantly compared to younger ones and to participants in the same age range of the control group (p = 0.032). No differences were found for severe hypoglycemia or diabetic ketoacidosis.

Conclusions: we conclude that older adolescents profit more from an MI/CBT intervention than younger ones do. Maybe a larger number of patients would prove an effect of MI and CBT in this difficult age group.