Table 3.

Recent controlled trials of family therapy in type 1 diabetes

Reference	Numbers of subjects	Type of diabetes	Age of subjects	Intervention	Timescale of intervention	Duration of follow-up	Outcomes
							Coping behaviors	Psychological well-being	Glycemic control
Wysocki et al59	119	1	11–17 years	BFST vs education and support vs current therapy	10 sessions over 3 months	12 months	Better adherence	Better parent–adolescent relationships. Less diabetes specific conflict	No improvement in glycemic control
Laffel et al60	100	1	8–17 years	Family focused teamwork targeting family involvement and coping	Sessions every 3–4 months over 1 year	1 years	Increased family involvement	No difference	Better HbA1c at 1 year
Ellis et al61,62	127	1	10–17 years	Addressed family processes, peer and community factors	Intervention group met 2–3 times/week for 6 months	2 years	Initial increase in SMBG was maintained in children from two-parent families but not single-parent families	Improved family relationships in two-parent (but not one-parent) families	Initial improvement in HbA1c but not maintained
Wysocki et al63–65	104	1	10–18 years	BFST-D vs education and support vs current therapy	12 sessions over 6 months	18 months	BFST-D improved problem solving. Overall no improvement in adherence	BFST-D produced better family interaction and less conflict at 18 months	BFST-D improved HbA1c vs other two groups. Improvement correlated with adherence
Murphy66	67	1	8–16 years	Parents and adolescents underwent diabetes skills training (2 sessions) and family teamwork (2 sessions)	Four 1 h sessions over 1 year	1 year	Increased parental involvement in attenders (P=0.01)		Improved in attenders (P=0.04)
Harris et al67	58	1	13–18 years	BFST	Ten 1.5 h individual sessions over 5–8 weeks. Home based			Reduction in diabetes-related and general family conflict	No correlation between HbA1c and family conflict
Murphy et al68	305 randomized. But 30% did not attend any training sessions	1	9–17 years	Parents and adolescents underwent skills training and family teamwork	Six 90-min monthly sessions	18 months	Adolescents perceived no change in parental input	No difference in QoL or well-being	No difference by intention to treat or per protocol
Nansel et al69	390	1	9–14 years	Clinic-based behavioral intervention: problem-solving, communication skills, and responsibility sharing	Intervention at every clinic visit, usually 3–4 monthly for 21 months	2 years	No positive effect on adherence behavior. Intervention group did less self-monitoring of blood glucose		Improved HbA1c in children aged 12–14 years: difference 0.32%, P=0.03. No effect in age 9–11 years

Abbreviations: BFST (-D), behavioral family systems therapy (for diabetes); SMBG, self-monitoring of blood glucose; QoL, quality of life; HbA_1c, glycosylated hemoglobin.