***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIMS To evaluate the effectiveness of a family-centred group education programme , in adolescents with Type 1 diabetes . METHODS Three hundred and five adolescents with Type 1 diabetes ; age 13.1 ± 1.9 years , diabetes duration 5.6 ± 3.3 years , BMI 20.9 ± 3.7 kg/m(2 ) , HbA(1c ) 78 ± 6 mmol/mol ( 9.3 ± 1.9 % ) were r and omly allocated to the Families and Adolescents Communication and Teamwork Study ( FACTS ) diabetes education programme ; ( six 90-min monthly sessions attended by parents and adolescents incorporating skills training and family teamwork ) or conventional clinical care . Primary outcome was HbA(1c ) at 18 months ( 12 months post-intervention ) . Secondary outcomes were HbA(1c ) at 9 months , psychosocial outcomes , adolescent quality of life , well-being , family responsibility and insulin dose adjustment behaviours at 12 months ( 6 months post-intervention ) and episodes of severe hypoglycaemia and diabetic ketoacidois during the 12 months post-intervention . All analyses are intention to treat . RESULTS Session attendance was poor with 48/158 families ( 30.4 % ) not attending any sessions and only 75/158 ( 47.5 % ) families attending ≥ 4 group education sessions . All biomedical and psychosocial outcomes were comparable between groups . At 18 months there was no significant difference in HbA(1c ) in either group and no between-group differences over time : intervention group 75 mmol/mol ( 9.0 % ) to 78 mmol/mol ( 9.3 % ) , control group 77 mmol/mol ( 9.2 % ) to 80 mmol/mol ( 9.5 % ) . Adolescents perceived no changes in parental input at 12 months . CONCLUSION Poor attendance of group education sessions delivered in routine clinics was a major challenge . More personalized educational approaches may be required to support and motivate families who are struggling to integrate the dem and s of intensive insulin regimens into their daily lives OBJECTIVE The objective of this study was to compare the relative effectiveness of two modes of delivering Behavioral Family Systems Therapy for Diabetes ( BFST-D ) to improve adherence and glycemic control among adolescents with type 1 diabetes with suboptimal glycemic control ( HbA1c ≥9.0 % [ ≥74.9 mmol/mol ] ) :  face to face in clinic ( Clinic ) and Internet videoconferencing ( Skype ) conditions . RESEARCH DESIGN AND METHODS Adolescents aged 12 to 18 years and at least one adult caregiver were r and omized to receive BFST-D via the Clinic or Skype condition . Participants completed up to 10 therapy sessions within a 12-week period . Changes in youth- and parent-reported adherence and glycemic control were compared before and after the intervention and at follow-up assessment . RESULTS Using an intent-to-treat analytic approach , no significant between-group differences were identified between the before , after , and follow-up assessment s. Groups were collapsed to examine the overall effects of BFST-D on adherence and glycemic control . Results identified that statistically significant improvements in adherence and glycemic control occurred from before to after the intervention ; improvements were maintained at 3-month follow-up . CONCLUSIONS Delivery of BFST-D via Internet-based videoconferencing is viable for addressing nonadherence and suboptimal glycemic control in adolescents with type 1 diabetes , potentially reducing important barriers to care for youth and families Background Few interventions have effectively improved health outcomes among youth with diabetes in chronic poor metabolic control . Purpose This study aims to determine whether multisystemic therapy ( MST ) , an intensive , home-based , tailored family treatment , was superior to weekly telephone support for improving regimen adherence and metabolic control among adolescents with chronic poor metabolic control . Methods A r and omized controlled trial was conducted with 146 adolescents with types 1 or 2 diabetes . Data were collected at baseline , 7 months ( treatment termination ) , and 12 months ( 6 months follow-up ) . Results Adolescents receiving MST had significantly improved metabolic control at 7 ( 1.01 % decrease ) and 12 months ( 0.74 % decrease ) compared to adolescents in telephone support . Parents of adolescents receiving MST reported significant improvements in adolescent adherence . However , adolescent-reported adherence was unchanged . Conclusions MST improved health outcomes among adolescents with chronic poor metabolic control  when compared to telephone support . Home-based approaches may provide a viable means to improve access to behavioral interventions for such youth OBJECTIVE Youth with type 1 diabetes frequently do not achieve glycemic targets . We aim ed to improve glycemic control with a Care Ambassador ( CA ) and family-focused psychoeducational intervention . RESEARCH DESIGN AND METHODS In a 2-yr , r and omized , clinical trial , we compared three groups : ( i ) st and ard care , ( ii ) monthly outreach by a CA , and ( iii ) monthly outreach by a CA plus a quarterly clinic-based psychoeducational intervention . The psychoeducational intervention provided realistic expectations and problem-solving strategies related to family diabetes management . Data on diabetes management and A1c were collected , and participants completed surveys assessing parental involvement in management , diabetes-specific family conflict , and youth quality of life ( QOL ) . The primary outcome was A1c at 2 yr ; secondary outcomes included maintaining parent involvement and avoiding deterioration in glycemic control . RESULTS We studied 153 youth ( 56 % female , median age 12.9 yr ) with type 1 diabetes ( mean A1c 8.4 ± 1.4 % ) . There were no differences in A1c across treatment groups . Among youth with suboptimal baseline A1c ≥ 8 % , more youth in the psychoeducation group maintained or improved their A1c and maintained or increased parent involvement than youth in the other two groups combined ( 77 vs. 52 % , p = 0.03 ; 36 vs. 11 % , p = 0.01 , respectively ) without negative impact on youth QOL or increased diabetes-specific family conflict . CONCLUSIONS No differences in A1c were detected among the three groups at 2 yr . The psychoeducational intervention was effective in maintaining or improving A1c and parent involvement in youth with suboptimal baseline glycemic control OBJECTIVE To evaluate the efficacy of two office-based treatments design ed to prevent deterioration in glycemic control in young adolescents with type 1 diabetes in a r and omized clinical trial . An individualized , more intensive family teamwork Coping skills program was compared with a diabetes Education treatment . RESEARCH DESIGN AND METHODS A baseline assessment was followed by four brief treatment sessions and immediate posttesting over the course of 1.5 years . Families of 226 early adolescents ( ages 11–14 ) were r and omized to receive either individualized coping skills education or diabetes education as adjunctive treatment  to quarterly medical appointments . Continued follow-up occurred at 3.5-month intervals for a long-term follow-up of up to 3 years . A post hoc Usual Care group facilitated comparisons of glycemic control . RESULTS Growth curve analysis showed that both treatment groups successfully prevented deterioration in adolescent disease care and simultaneously improved adolescent and parent quality of life that included indicators of more effective communication and reduced adherence barriers — without a concomitant increase in diabetes-related or general family conflict . However , contrary to expectation , the Education group was more efficacious than the Coping group in improvement of disease adherence and glycemic control over a 3-year follow-up . CONCLUSIONS Low-intensity office-based quarterly treatment can maintain or improve disease care adherence in early adolescence when provided to adolescent/parent dyads . Better outcomes are achieved when treatment goals and techniques match the needs of the targeted population Objective . The goal of this study was to determine whether multisystemic therapy ( MST ) , an intensive , home-based psychotherapy , could decrease diabetes-related stress among adolescents with chronically poorly controlled type 1 diabetes . Stress was also evaluated as a mediator of the effect of MST on adherence and metabolic control . Methods . A r and omized , controlled trial was conducted with 127 adolescents with type 1 diabetes mellitus and chronically poor metabolic control ( hemoglobin A1c levels of ≥8 % at study enrollment and for the past 1 year ) who received their diabetes care in a children 's hospital located in a major Midwestern city . Participants assigned r and omly to MST received treatment for ∼6 months . Data were collected at baseline and at a 7-month posttest ( ie , treatment termination ) . Changes in diabetes-related stress , as measured with a self-report question naire , were assessed . Structural equation models were used to test the degree to which changes in stress levels mediated the ability of the MST intervention to improve adherence and metabolic control . Results . In intent-to-treat analyses , participation in MST was associated with significant reductions in diabetes-related stress . Tests for moderation found no significant effects of age , gender , or ethnicity , which suggests that the intervention was equally effective in reducing diabetes stress for all participants . However , structural equation modeling did not provide support for diabetes stress as the mechanism through which MST improved health outcomes . Rather , the final model suggested that MST improved metabolic control through increased regimen adherence . Conclusions . Intensive , home-based psychotherapy reduces diabetes-related stress among adolescents with chronically poorly controlled type 1 diabetes . Such stress reductions are important for the psychological wellbeing of a subset of youths with diabetes who are at high risk for future health complications Children with type 1 diabetes are at risk for negative psychosocial and physiological outcomes , particularly as they enter adolescence . The purpose of this r and omized trial ( n = 82 ) was to determine the effects , mediators , and moderators of a coping skills training intervention  ( n = 53 ) for school-aged children compared to general diabetes education ( n = 29 ) . Both groups improved over time , reporting lower impact of diabetes , better coping with diabetes , better diabetes self-efficacy , fewer depressive symptoms , and less parental control . Treatment modality ( pump vs. injections ) moderated intervention efficacy on select outcomes . Findings suggest that group-based interventions may be beneficial for this age group OBJECTIVE — Studies showing that family communication and conflict resolution are critical to effective management of type 1 diabetes in adolescents have stimulated interest in evaluating psychological treatments targeting these processes . Previous trials have shown that Behavioral Family Systems Therapy ( BFST ) improved parent-adolescent relationships but not treatment adherence or glycemic control . This study evaluates a revised intervention , BFST for Diabetes ( BFST-D ) , modified to achieve greater impact on diabetes-related family conflict , treatment adherence , and metabolic control . RESEARCH DESIGN AND METHODS —A sample of 104 families of adolescents with inadequate control of type 1 diabetes was r and omized to either remain in st and ard care ( SC ) or to augmentation of that regimen by 12 sessions of either a multifamily educational support ( ES ) group or 12 sessions of BFST-D over 6 months . Pertinent measures were collected at baseline and at follow-up evaluations at 6 , 12 , and 18 months . RESULTS —BFST-D was significantly superior to both SC and ES in effects on A1C , while effects on treatment adherence and family conflict were equivocal . Improvement in A1C appeared to be mediated by improvement in treatment adherence . A significantly higher percentage of BFST-D youth achieved moderate or greater improvement ( > 0.5 SD ) in treatment adherence compared with the SC group at each follow-up and the ES group at 6 and 18 months . Change in treatment adherence correlated significantly with change in A1C at each follow-up . CONCLUSIONS —These results support the efficacy of BFST-D in improving A1C , but further research is needed to identify the mechanisms of this effect and to achieve cost-effective dissemination of the intervention OBJECTIVE This study reports 6- and 12-month follow-up for the families of adolescents with diabetes who participated in a trial of Behavioral-Family Systems Therapy ( BFST ) .  RESEARCH DESIGN AND METHODS A total of 119 families of adolescents with type 1 diabetes were r and omized to 3 months of treatment with either BFST , an education and support ( ES ) group , or current therapy ( CT ) .  Family relationships , adjustment to diabetes , treatment adherence , and diabetic control were assessed at baseline , after 3 months of treatment , and 6 and 12 months later . This report focuses on the latter two evaluations . RESULTS Compared with CT and ES , BFST yielded lasting improvements in parent-adolescent relationships and diabetes-specific conflict . Delayed effects on treatment adherence emerged at 6- and 12-month follow-ups . There were no immediate or delayed effects on adolescents ' adjustment to diabetes or diabetic control . CONCLUSIONS BFST 
    Output:
    
Summary Family-based interventions for youth with T1D appear effective at improving diabetes and family-centered outcomes .