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Improving Diabetes Management in Emerging Adulthood: An Intervention Development Study Using the Multiphase
April Idalski Carcone1, Deborah A Ellis1, Susan Eggly2
1Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, United States.
JMIR Research Protocols
|October 20, 2020
Summary
Emerging adults with type 1 diabetes can improve self-management through autonomy-supportive interventions. This study tests components like question prompts and motivational interviewing to enhance diabetes control.
Area of Science:
- Endocrinology and Metabolism
- Behavioral Science
- Adolescent Medicine
Background:
- Poor diabetes self-management in emerging adults (18-25 years) leads to adverse health outcomes and complications.
- Developmental focus on independence in emerging adults contributes to challenges in diabetes self-management.
- Self-determination theory (SDT) offers a framework for interventions promoting autonomy to improve diabetes outcomes.
Purpose of the Study:
- To test the efficacy of autonomy-supportive intervention components using a multiphase optimization strategy.
- To achieve a clinically significant improvement in metabolic control (HbA1c ≥ 0.5%) in adolescents and emerging adults (16-25 years) with poorly controlled type 1 diabetes (T1D).
- To optimize an intervention package for older adolescents and emerging adults with T1D.
Main Methods:
- Utilized a component selection experiment with an eight-arm full factorial design (2x2x2) testing Question Prompt List (QPL), Motivation Enhancement System (MES), and text message reminders.
- Assessed primary outcome of metabolic control via HbA1c at baseline, 2 months (treatment end), and 6 months (follow-up).
- Hypothesized mediators include SDT constructs (intrinsic motivation, self-efficacy, relatedness); moderators include depression and gender. Analyzed data using mixed-effects linear and generalized linear models.
Main Results:
- 20 participants enrolled and completed qualitative interviews on intervention components; analysis is ongoing.
- Clinical trial launched in Fall 2020, with enrollment through May 2023 and data collection through November 2023.
- The experiment is powered to detect main intervention effects on the primary outcome (HbA1c).
Conclusions:
- Anticipate empirical evidence to support a large-scale, multisite effectiveness trial.
- The optimized intervention package aims to improve diabetes self-management and metabolic control in emerging adults with T1D.
- Findings will inform future interventions targeting this high-risk population.
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