Psychosocial Benefits of Structured Support for Self-Care in Teens with Type 1 Diabetes (T1D)—Results of an RCT

Abstract

There are salient outcomes beyond A1c, including patient-reported outcomes, in the current era of diabetes interventions. The current study assessed psychosocial effects over 1 year in the Teenwork Study, an RCT utilizing text-messaging (TM) and problem solving (PS) interventions in a 2x2 factorial design, in teens with T1D. Teens ages 13-17 from 2 U.S. clinical sites were randomized to 4 groups: PS, TM, PS+TM, or usual care. The PS and PS+TM groups had quarterly intervention sessions with study staff targeting barriers and strategies to improve self-care related to BG monitoring and insulin administration. The TM and PS+TM groups received reminders to check BG levels at self-selected times from 1-4 times/day. All teens completed measures of affect around BG monitoring, depressive symptoms, self-efficacy, parent involvement in diabetes care, diabetes-specific family conflict, diabetes distress, and general quality of life at baseline and 1 year. Changes in survey scores from 0 to 12 months were analyzed by group assignment, controlling for baseline scores. The sample included 281 teens ([M±SD] age 15.0±1.3 years, T1D duration 6.6±3.8 years, 4.6±1.9 BG checks/day, A1c 8.5±1.1%). Teens were 51% male, 78% white, and 80% from 2-parent families; 64% used pump therapy. At entry, groups had similar demographic and diabetes characteristics. After 1 year, all 4 groups had a significant increase in independent care behaviors (less parent involvement) (p<.001). Teens in the PS+TM group had decreases in diabetes family conflict (p=.009) and diabetes distress (p=.01). There were no changes in other psychosocial measures. Increased independent self-care across groups was likely developmentally driven. Combined PS+TM reduced teen-reported diabetes family conflict and diabetes distress. Providing problem-solving skills at quarterly visits with text reminders between visits together may serve to encourage and empower teens with T1D, thus improving their psychosocial outcomes. Disclosure P.V. Commissariat: None. L. Volkening: None. D.A. Butler: None. B. Anderson: Advisory Panel; Self; Sanofi-Aventis. L.M. Laffel: Consultant; Self; Eli Lilly and Company, Novo Nordisk Inc., Sanofi US, MannKind Corporation, Roche Diagnostics Corporation, Dexcom, Inc., Insulet Corporation, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Johnson & Johnson Diabetes Institute, LLC..