Cardiovascular Disease (CVD) Decision Aid for Youth with Type 1 Diabetes (T1DM)—Perspectives of Health Care Providers (HCPs) with Pediatric-Onset T1DM

Abstract

CVD is the leading cause of premature death in people with T1DM, yet many individuals are unaware. Strategies to engage youth in CVD prevention and lifelong disease management are needed. The purpose of this study was to gain insight from HCPs about a shared decision making (SDM) aid centered on CVD modifiable risk factors (A1c, blood pressure (BP), and cholesterol), and designed to present facts, risks/benefits, and actionable steps relevant to teenagers. Five HCPs with pediatric onset T1DM, age 27-30y, working in a pediatric DM center, participated in multiple focus groups, to iteratively guide development of the SDM aid. Based on their experience in having T1DM and providing DM care to youth, HCPs offered perspectives on the aid in terms of value, content, delivery, and support mechanisms. Feedback was transcribed and summarized. HCPs agreed that introducing the topic of CVD to teenagers was important. Reflecting on their own experiences, HCPs regretted that the topic was not discussed during their pre-adult care conversations, which they said contributed to their unawareness of CVD prevention at the time. In terms of content, HCPs found the aid to be well suited for the intended audience, easy to understand, and not overwhelming. They thought illustrations were helpful to convey key facts and prevention messages, and voiced that even if it would be unlikely that their patients would have abnormal BP or lipids presently, educating about target values and testing intervals would be beneficial in preparation for adulthood. HCPs did not anticipate that the aid would cause distress, noting it was well balanced, informative, but not intimidating and refrained from scare tactics. HCPs unanimously agreed they would use the aid with patients (and parents), and recommended applying it when reviewing lab results. In summary, HCPS endorsed using the SDM aid to guide CVD discussions with youth. Studies are ongoing to assess its impact on youth with T1DM. Disclosure J. Krall: None. I. Libman: Consultant; Self; Novo Nordisk A/S. S. Afreen: None. L.M. Siminerio: None.