MI Studies Addressing Dyslipidemia and Diabetes Dietary Intervention Study in Children

The Dietary Intervention Study in Children (DISC) was a multicenter, randomized controlled trial sponsored by the National Heart, Lung, and Blood Institute to assess the efficacy of dietary counseling to decrease elevated serum lipids (LDL-C). Children with elevated LDL-C entered the initial clinical trial when they were 8 to 10 yr of age (34). As the intervention cohort moved into adolescence, the investigators elected to add an MI-based intervention to "renew" adherence to the prescribed diet among the original intervention group (there was no control group for this phase). The counselors were primarily masters-level health educators and dietitians who received 18 h of MI training. Each study participant received one in-person MI session and one follow-up session that was conducted either in person or by telephone. Twenty-four-hour recall data from the first 127 youths to complete the two-session protocol indicated that the proportion of calories from fat and dietary cholesterol was significantly reduced at the 3-mo follow-up assessment. The mean proportion of calories from fat also decreased from 27.7 to 25.6% (p < 0.001), and overall dietary adherence scores improved. When asked about their reaction to the counseling, 74% of the youths reported being satisfied or very satisfied.

Other Studies Targeting Diabetes

In a pilot study, Channon et al. tested the impact of MI on 22 adolescents, aged 14 to 18 yr, with diabetes (47). Participating youth received between one and nine MI sessions each, with an average of 4.7 sessions over 6 mo. The focus of the MI sessions consisted of awareness building (analyzing pros and cons), finding alternatives, problem solving, goal setting, and minimizing confrontation. Between 8 wk and 6 mo after the end of the intervention phase, patients who had received MI showed a significant reduction in HbA1c, from an average baseline measure of 10.8% to approx 10.0%.

Knight and et al. (48) administered an MI-based group intervention in six weekly, 1-h sessions to six youths, ages 13 to 16, with poorly controlled Type 1 diabetes. The intervention included externalizing conversations as well as MI. Participation in the MI-based group was compared with a "usual care" control group (n =14). At the 6-mo follow-up assessment, adolescents who had received the group MI were more likely than those youtsh in the control group to display positive shifts in their perception of diabetes such as increased feelings of control and acceptance. Changes in behavior or physiologic outcomes were not assessed.

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