Pilot Study Results for a Novel Behavior Plus Nutrition Intervention for Caregivers of Young Children with Type 1 Diabetes

OBJECTIVE: This pilot study presents results for a parent-based educational intervention targeting mealtime behaviors plus nutrition among families of young children (M age: 5.0±1.2 years) with type 1 diabetes mellitus (T1DM). METHODS: We recruited nine caregivers who participated in the six-session intervention and completed baseline and post-treatment assessments. RESULTS: Children’s mean daily glycemic levels decreased from 185±46 mg/dl to 159±40 mg/dl (p<0.001). There were also decreases in problematic parent and child mealtime behaviors. There was no change in children’s dietary intake indicators. CONCLUSIONS AND IMPLICATIONS: It appears promising that our targeted behavior plus nutrition intervention can improve glycemic control and behavior for young children with TDM. Our next step will be to modify the intervention to improve our nutrition education modules. Ultimately, we plan to test the intervention in a large randomized clinical trial to examine if it can yield improvements to children’s diet and glycated hemoglobin levels

Use of continuous glucose monitoring in young children with type 1 diabetes: implications for behavioral research

Patton SR, Williams LB, Eder SJ, Crawford MJ, Dolan L, Powers SW. Use of continuous glucose monitoring in young children with type 1 diabetes: implications for behavioral research.Objective: This study presents data on the use of continuous glucose monitoring (CGM) in young children with type 1 diabetes mellitus (T1DM). CGM provides moment-to-moment tracking of glucose concentrations and measures of intra- and interday variability, which are particularly salient measures in young children with T1DM.Methods: Thirty-one children (mean age = 5.0 yr ) with T1DM wore the Medtronic Minimed CGM for a mean of 66.8 h. The CGM was inserted in diabetes clinics, and parents were provided brief training.Results: Few difficulties were experienced and families cited the acceptability of CGM. Participants' CGM data are compared with self-monitoring blood glucose (SMBG) data as well as data from older children with T1DM to illustrate differences in methodology and variability present in this population. CGM data are used to calculate glucose variability, which is found to be related to diabetes variables such as history of hypoglycemic seizures.Conclusions: CGM is an acceptable research tool for obtaining glucose data in young children with T1DM and has been used previously in older children and adults. CGM may be particularly useful in young children who often experience more glucose variability. Data obtained via CGM are richer and more detailed than traditional SMBG data and allow for analyses to link blood glucose with behavior.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78635/1/j.1399-5448.2010.00649.x.pd

Adaptive Mobile Health Intervention for Adolescents with Asthma: Iterative User-Centered Development

Background: Adolescents diagnosed with persistent asthma commonly take less than 50% of their prescribed inhaled corticosteroids (ICS), placing them at risk for asthma-related morbidity. Adolescents’ difficulties with adherence occur in the context of normative developmental changes (eg, increased responsibility for disease management) and rely upon still developing self-regulation and problem-solving skills that are integral for asthma self-management. We developed an adaptive mobile health system, Responsive Asthma Care for Teens (ReACT), that facilitates self-regulation and problem-solving skills during times when adolescents’ objectively measured ICS adherence data indicate suboptimal rates of medication use. Objective: The current paper describes our user-centered and evidence-based design process in developing ReACT. We explain how we leveraged a combination of individual interviews, national crowdsourced feedback, and an advisory board comprised of target users to develop the intervention content. Methods: We developed ReACT over a 15-month period using one-on-one interviews with target ReACT users (n=20), national crowdsourcing (n=257), and an advisory board (n=4) to refine content. Participants included 13-17–year-olds with asthma and their caregivers. A total of 280 adolescents and their caregivers participated in at least one stage of ReACT development. Results: Consistent with self-regulation theory, adolescents identified a variety of salient intrapersonal (eg, forgetfulness, mood) and external (eg, changes in routine) barriers to ICS use during individual interviews. Adolescents viewed the majority of ReACT intervention content (514/555 messages, 93%) favorably during the crowdsourcing phase, and the advisory board helped to refine the content that did not receive favorable feedback during crowdsourcing. Additionally, the advisory board provided suggestions for improving additional components of ReACT (eg, videos, message flow). Conclusions: ReACT involved stakeholders via qualitative approaches and crowdsourcing throughout the creation and refinement of intervention content. The feedback we received from participants largely supported ReACT’s emphasis on providing adaptive and personalized intervention content to facilitate self-regulation and problem-solving skills, and the research team successfully completed the recommended refinements to the intervention content during the iterative development process

Responsive Asthma Care for Teens (ReACT): Development protocol for an adaptive mobile health intervention for adolescents with asthma

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.Introduction Asthma is a leading cause of youth morbidity in the USA, affecting >8% of youth. Adherence to inhaled corticosteroids (ICS) can prevent asthma-related morbidity; however, the typical adolescent with asthma takes fewer than 50% of their prescribed doses. Adolescents are uniquely vulnerable to suboptimal asthma self-management due to still-developing executive functioning capabilities that may impede consistent self-regulation and weaken attempts to use problem solving to overcome barriers to ICS adherence. Methods and analysis The aims of this project are to improve adherence to ICS as an important step towards better self-management among adolescents aged 13–17 years diagnosed with asthma by merging the efficacious behaviour change strategies found in behavioural health interventions with scalable, adaptive mobile health (mHealth) technologies to create the Responsive Asthma Care for Teens programme (ReACT). ReACT intervention content will be developed through an iterative user-centred design process that includes conducting (1) one-on-one interviews with 20 teens with asthma; (2) crowdsourced feedback from a nationally representative panel of 100 adolescents with asthma and (3) an advisory board of youth with asthma, a paediatric pulmonologist and a behavioural health expert. In tandem, we will work with an existing technology vendor to programme ReACT algorithms to allow for tailored intervention delivery. We will conduct usability testing of an alpha version of ReACT with a sample of 20 target users to assess acceptability and usability of our mHealth intervention. Participants will complete a 4-week run-in period to monitor their adherence with all ReACT features turned off. Subsequently, participants will complete a 4-week intervention period with all ReACT features activated. The study started in October 2018 and is scheduled to conclude in late 2019. Ethics and dissemination Institutional review board approval was obtained at the University of Kansas and the University of Florida. We will submit study findings for presentation at national research conferences that are well attended by a mix of psychologists, allied health professionals and physicians. We will publish study findings in peer-reviewed journals read by members of the psychology, nursing and pulmonary communities

Diabetes conflict outstrips the positive impact of self‐efficacy on youth adherence and glycemic control in type 1 diabetes

This is the peer reviewed version of the following article: Diabetes Conflict Outstrips the Positive Impact of Self-Efficacy on Youth Adherence and Glycemic Control in Type 1 Diabetes, Amy E. Noser, Lindsay Huffhines, Mark A. Clements, Susana R. Patton Pediatr Diabetes. 2017 Nov; 18(7): 614–618. Published online 2016 Nov 17. doi: 10.1111/pedi.12471, which has been published in final form at https//doi.org/10.1111/pedi.12471. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.Objective To examine whether self‐efficacy buffers the deleterious consequences of diabetes‐specific family conflict on self‐monitoring blood glucose (SMBG) and glycated hemoglobin (HbA1c) in youth with type 1 diabetes mellitus (T1DM). Methods A total of 129 youth with T1DM (aged 10‐16 years) completed measures of diabetes‐specific family conflict and self‐efficacy for diabetes management, and their blood glucose meter data and HbA1c were extracted from the electronic medical record. We preformed moderation analyses to examine whether self‐efficacy moderated the association that diabetes‐specific family conflict had with SMBG and HbA1c. We used simple slopes analyses to probe significant interactions. Results Our results indicated that self‐efficacy moderated the association that diabetes‐specific family conflict had with SMBG and HbA1c. The pattern of these findings showed that high self‐efficacy buffered the negative impact of diabetes conflict on HbA1c. However, benefits of high self‐efficacy for more frequent SMBG was only apparent in the context of low diabetes‐specific family conflict. Conclusions Study findings highlight the interactive relationship between diabetes‐specific family conflict and self‐efficacy in relation to SMBG and glycemic control. These findings suggest that family functioning and youth's self‐efficacy are promising intervention targets for families having trouble with SMBG and HbA1c