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Motivational Interview to improve vascular health in Adolescents with poorly controlled type 1 Diabetes (MIAD): a randomized controlled trial
INTRODUCTION: We studied if motivational interviewing (MI) added to standard educational care (SEC) improves vascular health in adolescents with poorly controlled type 1 diabetes. RESEARCH DESIGN AND METHODS: 47 adolescents with type 1 diabetes of at least 2 years duration and hemoglobin A1c >75 ...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BMJ Publishing Group
2020
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7388880/ https://www.ncbi.nlm.nih.gov/pubmed/32723754 http://dx.doi.org/10.1136/bmjdrc-2020-001216 |
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author | Pulkkinen, Mari-Anne Tuomaala, Anna-Kaisa Hero, Matti Gordin, Daniel Sarkola, Taisto |
author_facet | Pulkkinen, Mari-Anne Tuomaala, Anna-Kaisa Hero, Matti Gordin, Daniel Sarkola, Taisto |
author_sort | Pulkkinen, Mari-Anne |
collection | PubMed |
description | INTRODUCTION: We studied if motivational interviewing (MI) added to standard educational care (SEC) improves vascular health in adolescents with poorly controlled type 1 diabetes. RESEARCH DESIGN AND METHODS: 47 adolescents with type 1 diabetes of at least 2 years duration and hemoglobin A1c >75 mmol/mol (>9.0%) on two visits were randomized to MI+SEC or SEC. We also compared vascular health parameters of patients with type 1 diabetes at trial baseline with a group of healthy historical controls matched for age and body size. RESULTS: 39 adolescents (20 MI+SEC) completed the vascular health study. At 12 months, parameter changes were not statistically significantly different between MI+SEC and SEC (carotid-femoral pulse wave velocity (cfPWV): mean difference 0.052 m/s (95% CI −0.395 to 0.500, p=0.81); carotid-radial PWV (crPWV): 0.118 m/s (95% to 0.478 to 0.713, p=0.69), carotid intima-media thickness (IMT): 0.002 mm (95% CI −0.37 to 0.40, p=0.93), systolic blood pressure (BP) z-score: 0.495 (95% CI −0.099 to 1.09, p=0.10). At baseline, duration of type 1 diabetes was associated with radial IMT (r=0.430, p=0.007) and cfPWV (r=0.373, p=0.018), and carotid, femoral and brachial IMT were correlated with continuous glucose monitoring (CGM) SD (r=0.440, p=0.017; r=0.377, p=0.048; r=0.387, p=0.038). There was an inverse association between CGM time-in-range (3.9–10.0 mmol/L) and crPWV (r=−0.476, p=0.022) changes. Systolic BP change was associated with body mass index change (r=0.374, p=0.019) and IMT change (r=0.461, p=0.016 for carotid IMT; r=0.498, p=0.010 for femoral IMT). PWVs were higher and common carotid compliance lower among patients with type 1 diabetes at baseline compared with healthy controls, but no other differences were found. CONCLUSION: There was no effect of MI added to SEC on vascular health parameters. Although disease duration and glycemic control were associated with vascular health at baseline, there were only limited associations between glycemic control and vascular health parameter changes. Vascular health parameter changes were interrelated suggesting clustering of cardiovascular risk. TRIAL REGISTRATION NUMBER: NCT02637154. |
format | Online Article Text |
id | pubmed-7388880 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-73888802020-08-11 Motivational Interview to improve vascular health in Adolescents with poorly controlled type 1 Diabetes (MIAD): a randomized controlled trial Pulkkinen, Mari-Anne Tuomaala, Anna-Kaisa Hero, Matti Gordin, Daniel Sarkola, Taisto BMJ Open Diabetes Res Care Cardiovascular and Metabolic Risk INTRODUCTION: We studied if motivational interviewing (MI) added to standard educational care (SEC) improves vascular health in adolescents with poorly controlled type 1 diabetes. RESEARCH DESIGN AND METHODS: 47 adolescents with type 1 diabetes of at least 2 years duration and hemoglobin A1c >75 mmol/mol (>9.0%) on two visits were randomized to MI+SEC or SEC. We also compared vascular health parameters of patients with type 1 diabetes at trial baseline with a group of healthy historical controls matched for age and body size. RESULTS: 39 adolescents (20 MI+SEC) completed the vascular health study. At 12 months, parameter changes were not statistically significantly different between MI+SEC and SEC (carotid-femoral pulse wave velocity (cfPWV): mean difference 0.052 m/s (95% CI −0.395 to 0.500, p=0.81); carotid-radial PWV (crPWV): 0.118 m/s (95% to 0.478 to 0.713, p=0.69), carotid intima-media thickness (IMT): 0.002 mm (95% CI −0.37 to 0.40, p=0.93), systolic blood pressure (BP) z-score: 0.495 (95% CI −0.099 to 1.09, p=0.10). At baseline, duration of type 1 diabetes was associated with radial IMT (r=0.430, p=0.007) and cfPWV (r=0.373, p=0.018), and carotid, femoral and brachial IMT were correlated with continuous glucose monitoring (CGM) SD (r=0.440, p=0.017; r=0.377, p=0.048; r=0.387, p=0.038). There was an inverse association between CGM time-in-range (3.9–10.0 mmol/L) and crPWV (r=−0.476, p=0.022) changes. Systolic BP change was associated with body mass index change (r=0.374, p=0.019) and IMT change (r=0.461, p=0.016 for carotid IMT; r=0.498, p=0.010 for femoral IMT). PWVs were higher and common carotid compliance lower among patients with type 1 diabetes at baseline compared with healthy controls, but no other differences were found. CONCLUSION: There was no effect of MI added to SEC on vascular health parameters. Although disease duration and glycemic control were associated with vascular health at baseline, there were only limited associations between glycemic control and vascular health parameter changes. Vascular health parameter changes were interrelated suggesting clustering of cardiovascular risk. TRIAL REGISTRATION NUMBER: NCT02637154. BMJ Publishing Group 2020-07-28 /pmc/articles/PMC7388880/ /pubmed/32723754 http://dx.doi.org/10.1136/bmjdrc-2020-001216 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Cardiovascular and Metabolic Risk Pulkkinen, Mari-Anne Tuomaala, Anna-Kaisa Hero, Matti Gordin, Daniel Sarkola, Taisto Motivational Interview to improve vascular health in Adolescents with poorly controlled type 1 Diabetes (MIAD): a randomized controlled trial |
title | Motivational Interview to improve vascular health in Adolescents with poorly controlled type 1 Diabetes (MIAD): a randomized controlled trial |
title_full | Motivational Interview to improve vascular health in Adolescents with poorly controlled type 1 Diabetes (MIAD): a randomized controlled trial |
title_fullStr | Motivational Interview to improve vascular health in Adolescents with poorly controlled type 1 Diabetes (MIAD): a randomized controlled trial |
title_full_unstemmed | Motivational Interview to improve vascular health in Adolescents with poorly controlled type 1 Diabetes (MIAD): a randomized controlled trial |
title_short | Motivational Interview to improve vascular health in Adolescents with poorly controlled type 1 Diabetes (MIAD): a randomized controlled trial |
title_sort | motivational interview to improve vascular health in adolescents with poorly controlled type 1 diabetes (miad): a randomized controlled trial |
topic | Cardiovascular and Metabolic Risk |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7388880/ https://www.ncbi.nlm.nih.gov/pubmed/32723754 http://dx.doi.org/10.1136/bmjdrc-2020-001216 |
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