A Hybrid Effectiveness-implementation Trial to Reduce Diabetes Distress in Teenagers

About this study

The investigators will assess both effectiveness (primary) and implementation (secondary) outcomes for a distress-reducing intervention, Supporting Teen Problem Solving (STePS). STePS has already undergone an efficacy trial. The current study allows for evaluating the outcomes of STePS by delivering it in real-world settings, using real-world providers. The investigators will train these behavioral health providers who are already embedded in diabetes clinics to use the STePS intervention. The investigators will also compare two approaches to intervention delivery: in-person versus telehealth. The investigators have recruited 6 different study sites across the country, representing diversity in rural vs. urban, public vs private insurance, as well as in ethnic and racial background of the participants. 360 teens will be enrolled and randomized to either STePS or an educational control group on a 1:1:1 basis at each of our 6 study sites: STePS in-person (n=120), STePS telehealth (n=120), or educational control via telehealth (n=120). All 3 groups will be delivered as 4.5-month interventions, consisting of 9 sessions offered twice per month. Quantitative data (surveys) will be collected for all participants at baseline, immediately post-intervention, and 6 \& 12 months post-intervention. Qualitative data will also be collected post-intervention through focus groups. Aim 1. To test, in 360 teens across 6 clinical sites, the effectiveness of STePS in improving diabetes- specific emotional distress and preventing worsening glycemic control, both immediately post intervention and over time. Hypothesis 1a: STePS will lead to clinically meaningful and statistically significant improvements in diabetes distress. Hypothesis 1b: STePS will prevent the worsening of glycemic control (A1C and Time in Range). These hypotheses are consistent with the efficacy trial and will prove effectiveness when implemented in real- world settings. Aim 2. To assess the implementation of STePS among key stakeholders (teen participants, interventionists). Recruitment, enrollment, representativeness, feasibility, acceptability, appropriateness, fidelity, and costs will be assessed as well as preferred implementation approaches. Hypothesis 2a. Stakeholders will find few perceived barriers to implementing STePS and many perceived facilitators for adopting it in their clinical settings. Hypothesis 2b. Implementation strategies will be plausible in diabetes clinics across the country.

Diabetes distress among teens is common and associated with poor glycemic control and poor psychosocial outcomes. Diabetes-specific emotional distress (abbreviated DD in this proposal) is emotional distress culminating from living with diabetes and the burden of relentless daily self-management. Teens are at high risk for DD as diabetes self-management behaviors decline, and glycemic control worsens. Only 17% of teens achieve recommended glycemic targets for time-in-range (TIR) of 70-180 mg/dL and hemoglobin A1c \<7.0%.7,8 DD is highly prevalent in teenagers (21%-52%) and is associated with suboptimal glycemic control, and an increased risk of future complications, even when controlling for demographic variables such as race and socioeconomic status. DD is a stronger predictor of A1c than …

• Ann and Robert H Lurie Childrens Hospital of Chicago

  Chicago, Illinois

  I'm interested

Only the research team can confirm whether you qualify. The intake questionnaire is the best way to find out.