%0 Journal Article
%T Improving the Care of Youth With Type 1 Diabetes With a Novel Medical
%A Catherine Pihoker
%A Christian L. Roth
%A Craig E. Taplin
%A Faisal S. Malik
%A Joyce P. Yi-Frazier
%A Kathryn B. Whitlock
%A Waylon Howard
%J The Diabetes Educator
%@ 1554-6063
%D 2018
%R 10.1177/0145721717750346
%X The purpose of this study was to examine the feasibility and efficacy of the Diabetes Community Care Ambassador (DCCA) Program, a novel medical-legal community intervention designed to support high-risk youth with type 1 diabetes. Study eligibility criteria: ages 3-19 years, A1C ¡Ý8.5% (¡Ý69 mmol/mol) and/or recent diabetic ketoacidosis hospitalization, type 1 diabetes duration ¡Ý1 year, and English- or Spanish-speaking. Eighty-nine youth and their caregivers participated in the 9- to 12-month intervention, which included diabetes education and support through 3 home visits, 1 to 2 school visits, and phone support from a lay health worker, as well as legal support from a medical-legal partnership attorney. Feasibility was assessed; change in A1C was compared in a linear mixed model. Of the 89 DCCA Program participants, 80% completed the program, with the majority of participants rating their DCCA favorably. Sixty-two percent reported ¡Ý1 unmet legal need, of whom 29% accepted legal counsel. Youth enrolled in the DCCA Program demonstrated an improvement in glycemic control as their mean A1C decreased from 9.71% (83 mmol/mol) at the start of the program to 9.40% (79 mmol/mol) at the end of the intervention period (P = .03). Participants with public health insurance experienced the greatest differential A1C reduction (9.79% to 9.11%, 83 mmol/mol to 76 mmol/mol). The DCCA Program represents a promising intervention for improving care of high-risk youth with type 1 diabetes. A significant proportion of caregivers of youth reported having an unmet legal need. Participants remained highly engaged and demonstrated improved glycemic control, particularly youth with public health insurance
%U https://journals.sagepub.com/doi/full/10.1177/0145721717750346