Yale School of Nursing Associate Dean Margaret Grey, DrPH, PNP, FAAN, has been awarded a $2.4 million federal grant to expand work on her program for adolescents with diabetes, an intervention that she demonstrated to significantly improve control of the disease and raise quality of life.
Funding will come from the National Institute of Nursing Research, one of the National Institutes of Health. NINR also funded Grey’s original coping skills study, which was completed in 1998. Grey developed a 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. After six months, youths who had the skills training showed a 42 percent improvement in metabolic control, which is highly significant in 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, they can expect a 25 percent 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 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. “We want to see if we can make the transitions into and out of adolescence any easier,” Grey said. 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. In fact, prior to Grey’s 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, Grey said. 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 said.
Grey’s co-investigators included YSN Dean Catherine Gilliss, YSN Associate Professor Donna Mahrenholz, YSM Professor of Pediatrics William Tamborlane, and Associate Professor of Epidemiology and Public Health William White.
