Adaptation of an adult web application for type 1 diabetes self-management to youth: use of the Behaviour Change Wheel to tailor the needs of healthcare transition- A qualitative study (Preprint)

Facilitating the Virtual Exercise Games for Youth with T1D (ExerT1D) Peer Intervention: Protocol Development and Feasibility

Background

Barriers to moderate-to-vigorous physical activity (MVPA) for adolescents with type 1 diabetes (T1D) include physiology, transition to autonomy, and diabetes-specific stigma. Opportunities for T1D peer activities with T1D role model support are limited. To address this need, our single-arm pilot study tested the Home-based Virtual Activity Program for Youth with T1D (HAP-V-T1D) for feasibility.

Methods

Participants (n=15) were mean age 15.6 [SD 1.5] years, 7 non-Hispanic white, 6 female, 2 non-binary, mean A1c 8.9%±2.2%. The program included an MVPA videogame, physician-led education regarding managing T1D around MVPA, objective habitual MVPA goal-setting , and T1D management skills guided by young adult instructors living with T1D.

Results

For feasibility, 13/15 participants attended 10/12 sessions. Participants' perceptions of the program, comfort, instructors, and group cohesion were rated high/very high (4.2±0.5 to 4.8±0.3 out of 5).Motivation for the videogame was also high (4.1±0.4 out of 5). Instructor-adolescent interactions related to building T1D management skills were rated as excellent for 78% of sessions. Similarly, sharing knowledge and experiences were rated as excellent for 68% of sessions. However, adolescent-adolescent interactions were poor (communication 29% excellent, peer interactions 8% excellent). The most reported barriers to participation were negative mood and oversleeping. No participants experienced diabetic ketoacidosis, severe hypoglycemia, or injuries during the study period. Compared to baseline, glycemic metrics appeared to decrease during and post intervention (d= -0.72, -1.12).

Conclusion

HAP-V-T1D facilitated unprecedented T1D peer support achievements by engaging diverse youth with T1D in an MVPA program led by T1D role models. Larger studies are needed to assess if this intervention can improve glycemic measures and reduce diabetes-specific stigma.

Psychological separation, health locus of control, and transition readiness in adolescents and young adults with type I diabetes

PURPOSE

The purpose of this study was to examine the effects of psychological separation and health locus of control on the health care transition readiness of adolescents and young adults (AYAs) with type 1 diabetes.

METHODS

Data were collected between December 2020 and October 2021. One hundred twelve AYAs with type 1 diabetes treated at a tertiary hospital and under follow-up observation as well as AYAs with type 1 diabetes nationwide who were part of the type 1 diabetes internet community were enrolled. The Psychological Separation Inventory, the Multidimensional Health Locus of Control scale from C, and the Self-management and Transition to Adulthood with Therapeutics = Rx Questionnaire were used.

RESULTS

Multiple regression analysis indicated that age (β = 0.302, p = .001), hemoglobin A1c (HbA1c) (β = -0.174, p = .040), conflictual separation (β = 0.242, p = .005), functional separation (β = 0.200, p = .045) and attitudinal separation (β = -0.240 p = .015) were significantly associated with health management transition readiness; these predictors explained 27.6% of health care transition readiness (F = 8.062, p = .000).

CONCLUSIONS

AYAs with type 1 diabetes can enhance readiness for health care transition by fostering psychological separation from parents, effectively managing blood glucose levels, and taking into account age-related factors during the preparation process. At this point, it is essential for healthcare professionals to guide parents in recognizing adolescents' psychological independence and facilitating their supportive role through the process of redefining their roles.

PRACTICE IMPLICATIONS

Health care providers should promote psychological separation in AYAs. Additionally, taking into account the developmental characteristics of adolescence can facilitate a successful health care transition.

5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2024

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

14. Children and Adolescents: Standards of Care in Diabetes-2024

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.