EMPoWER Study - Strengths-based Behavioral Intervention for Youth With Type 1 Diabetes

Baylor College of Medicine250 enrolled

Overview

The EMPoWER Study randomized clinical trial is a strengths-based behavioral intervention delivered to youth with type 1 diabetes (age 10 to 13) and their parents. The purpose of the intervention is to improve glycemic, behavioral, and psychosocial outcomes in youth with diabetes using a multiple systems approach that engages youth, their parents, and diabetes care providers to identify and build youths' diabetes strengths. The primary aim of this study is to assess the intervention impact on glycemic control, adherence, and health-related quality of life (HRQOL). Secondary aims are to evaluate behavioral mediators of intervention impact and to examine intervention dose as a mediator of intervention impact.

The goal of the randomized clinical trial (RCT) is to learn if a brief behavioral intervention targeting multiple systems ("Type 1 Doing Well" Program) can improve glycemic, behavioral, and psychosocial outcomes in youth with type 1 diabetes. Youth, age 10 to 13, will enroll with one parent or legal guardian to participate in the study with them. Researchers will compare the Type 1 Doing Well (T1DW) Program arm to the Enhanced Usual Care (EUC; "Diabetes-Related Information and Resources" Program) arm. Parent-youth dyads in both study arms will provide data (e.g. questionnaires, A1c, medical chart and diabetes device data) at four timepoints throughout the duration of the study. Following baseline data collection, parent-youth dyads will complete an orientation session with study team members to be randomized to their study arm and review study activities. Parent and youth will also be invited to complete a feedback interview on their experience with the program they received. The intervention will take place during the 6-month intervention period, and participants will be randomly allocated to 1 of two intervention conditions: 1. Parents and youth in the T1DW Program condition (intervention) will use a web-based mobile application to do daily and weekly activities focused on recognizing and reinforcing youths' diabetes strengths. They will also have a conversation with the youth's diabetes provider about what is going well in diabetes care at a routine diabetes appointment. 2. Parents and youth in the EUC Program condition will receive and review 6 monthly diabetes-related information and resources in the form of electronic handouts. In preparation for the randomized clinical trial of a new behavioral intervention for preteens with type 1 diabetes and their parents, the study is also enrolling adolescents with type 1 diabetes to create videos about living well with type 1 diabetes. The videos will be used in the intervention materials for the randomized clinical trial. Diabetes care providers at each of the sites will also be enrolled in the study. Provider participants will receive a brief training to deliver the strength-based conversation with parent-youth dyads in the T1DW Program arm, and they will complete study-related questionnaires about their experiences delivering the strengths-based conversation component of the intervention.

Interventions

Type 1 Doing Well (T1DW) ProgramBEHAVIORAL

Parent and youth will each have access to a version of the app. The study app activities include parents and youth: * noticing what the youth does well for diabetes; * setting and tracking a family diabetes goal in the app; and * having a weekly meeting to review what the youth is doing well with diabetes and progress on the family diabetes goal. Parents and youth will also have access to age-appropriate libraries of videos with diabetes-specific content. Parents and youth will also have a conversation with the youth's diabetes care provider at a regularly scheduled diabetes appointment at participating hospital sites.

Parent and youth will receive diabetes-related information and resources in the form of electronic handouts. They will receive one handout per month by email during the 6-month intervention period. These handouts include a variety of diabetes-related topics curated by the study team. Handouts will not include any specific information about the youth's health.

Eligibility

Sex: ALLMin age: 10 YearsMax age: 99 Years

Medical Language ↔ Plain English

For Trial Participants - Inclusion Criteria: Youth * type 1 diabetes diagnosis per ADA criteria for at least 6 months, * age 10 to 13 years at consent, * English or Spanish fluency, * At least one hemoglobin A1c value ≥ 8 % (percent) within the past 12 months * Patient at one of the participating study sites Parent/legal guardian of youth * Age at least 18 years old at time of consent, * English or Spanish fluency, * Consistent access to a mobile phone that has texting capabilities and a device with internet access Exclusion Criteria: Youth Being treated for: * a major serious or acute medical condition or comorbidity (e.g. cancer, cystic fibrosis), * a major serious psychological or psychiatric condition, * a major serious developmental condition that would interfere with capacity for informed assent or participation or that would confound outcomes Parents/legal guardian of youth participant Being treated for: * a major serious or acute medical condition or comorbidity (e.g. cancer, cystic fibrosis), * a major serious psychological or psychiatric condition, * a major serious developmental condition that would interfere with capacity for informed consent or participation or that would confound outcomes Other Exclusion Criteria * Plans to move diabetes care out of participating hospital site within next 6 months, * Legal guardianship of the youth with diabetes being unclear at the time of screening or recruitment, * Study team learning of other involvement with the legal system during screening or recruitment For the Teen Videos: Inclusion Criteria: * self-reported type 1 diabetes diagnosis for ≥ 1 year, * age 14-17 at consent, * English fluency, * living in the United States Exclusion Criteria: * major psychiatric or developmental disorders in youth or parents that would interfere with capacity for informed consent or participation, * major medical comorbidities that would confound outcomes (e.g., cancer, cystic fibrosis). Diabetes Care Provider Participants Inclusion Criteria: \- Provider at one of the sites' diabetes care centers

Outcomes

Primary Outcomes

Demographic and Medical Information Questionnaire

Only demographic information and limited diabetes treatment information will be collected about participants in the teen videos portion of this study. Participants will complete a brief questionnaire developed by the study team, which will request self-reported information about participant demographics (e.g., race, ethnicity, gender) and medical information (e.g., time since diabetes diagnosis, current treatments).

Time frame: Baseline

Glycemic Control - HbA1c

Point of care HbA1c values documented by the medical team at each clinic visit will be collected from the electronic health record, to assess change in glycemic outcomes. Youth will be asked to complete a home dry blood spot A1c kit at three study timepoints unless an A1c value is documented in the electronic health record within the required timeframe. The study team will mail youth a home kit with instructions, all necessary materials to collect the sample, and a pre-paid mailer to ship it back. Higher HbA1c indicates higher average blood glucose values over the previous 2-3 months, which represents poorer glycemic control.

Time frame: Baseline, 6 months, 12 months

Glycemic Control - time-in-range

When available for youth who use a continuous glucose monitor (CGM), 14 days' of CGM data will be downloaded at each time point by the study teams to calculate glucose time-in-range as an additional index of glycemic control. Higher time-in-range is an indicator of better glycemic control.