Type 1 Diabetes
Conditions
Keywords
pediatric, continuous glucose monitor, insulin pump, automated insulin delivery, hybrid closed loop systems, medical education, diabetes technology
Brief summary
This study aims to identify the unmet psychoeducational needs of parents of children 8-12 years of age using insulin pump and CGM for pediatric T1D management and to leverage that information to develop an innovative app-based psychoeducational intervention to optimize use of these technologies and improve T1D outcomes.
Detailed description
Despite increased use of insulin pumps and continuous glucose monitors (CGM) for pediatric type 1 diabetes (T1D) management and research studies showing benefits from the use of these devices, real-world glycemic control among youth with T1D has worsened in recent years. Although greater youth and parental diabetes knowledge is associated with better glycemic control, education alone is not sufficient to bring about the behavioral changes needed to improve outcomes in T1D. Psychoeducation recognizes the need to blend educational and behavioral approaches, including problem-solving and goal-setting, to support parents in developing optimal T1D management approaches. There are currently a lack of effective standardized tools to support patients and families in developing the knowledge and behavioral strategies needed to optimize the use of diabetes technologies. The development of innovative family-centered psychoeducational tools addressing both behavior and knowledge will help to realize the full potential of diabetes technologies to improve glycemic control and quality of life while ultimately preventing or delaying the development of both acute and long-term complications of T1D. Interviews with parent-child dyads and diabetes clinicians will be used to identify the unmet parental psychoeducational needs regarding insulin pumps and CGM. These results will inform the use of instructional design to adapt an existing app-delivered diabetes technology curriculum to meet the specific needs of parents of children with T1D. Finally, the investigators will assess the feasibility and acceptability of this novel family-facing psychoeducational app-delivered intervention in a non-randomized pilot study.
Interventions
OTHERTeKnO T1D: Parents
app-delivered curriculum to provide psychoeducational education surrounding diabetes technology use
Sponsors
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Children's Hospital of Philadelphia
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
8 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. child 8-12 years of age with a diagnosis of T1D ≥ 6 months 2. currently using insulin pump( IP) and CGM ≥ 1 month \[including Hybrid Closed Loop (HCL) systems\] 3. participation of primary diabetes caregiver 4. English fluency 5. mean A1c \>7.5% over the past 6 months (Aim 3 only)
Exclusion criteria
1. major illnesses other than T1D in the child 2. significant cognitive limitations or major psychiatric disorders in the child or parent 3. the use of medications other than insulin to control blood glucose levels.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Perceived Intervention Utility | Arm 3: Months 30-60 | Score on a survey developed to assess the perceived utility of the Technology Knowledge Optimization Type 1 Diabetes: Parents curriculum during Arm 3. Scores range from 0-100 with higher scores reflecting greater perceived utility. |
| Intervention Satisfaction | Arm 3: Months 30-60 | Score on a survey developed to assess satisfaction with the Technology Knowledge Optimization Type 1 Diabetes: Parents curriculum in Arm 3. Scores range from 0-100 with higher scores reflecting greater satisfaction. |
| Study Recruitment | Arm 3: Months 30-60 | Percentage of eligible patients who are approached and enroll in the study in Arm 3. |
| Intervention Retention | Arm 3: Months 30-60 | Percentage of enrolled participants who complete the entire intervention for Arm 3. |
| Intervention Completion | Arm 3: Months 30-60 | Percentage of enrolled participants who complete the TeKnO T1D: Parents Curriculum in Arm 3. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| CGM Coefficient of Variation of the Mean | Arm 3: Months 30-60 | The Coefficient of Variation of the Mean will be assessed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. . |
| CGM Time in Range (70-180 mg/dL) | Arm 3: Months 30-60 | CGM Time in Range (70-180 mg/dL) will be assessed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. |
| CGM Time Below Range (<70 mg/dL) | Arm 3: Months 30-60 | CGM Time Below Range (\<70 mg/dL) will be assessed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. |
| CGM Time Above Range (<180 mg/dL) | Arm 3: Months 30-60 | CGM Time Above Range (\<180 mg/dL) will be assessed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. |
| CGM Wear Time | Arm 3: Months 30-60 | The percentage of CGM wear time will be assessed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. |
| Total Daily Basal Insulin Dose | Arm 3: Months 30-60 | Total Daily Basal Insulin Dose will be assessed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. |
| Percent Basal Insulin Dose | Arm 3: Months 30-60 | The percentage of the total daily insulin derived from basal insulin (basal insulin/ total daily insulin dose) will be assessed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. |
| Number of boluses per day | Arm 3: Months 30-60 | The number of boluses per day will be assessed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. |
| Carbohydrate intake logged on insulin pump | Arm 3: Months 30-60 | The number of grams of carbohydrate intake logged on insulin pump will be assessed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. |
| Total Daily Insulin Dose | Arm 3: Months 30-60 | Total Daily Insulin Dose will be assessed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. |
| Hemoglobin A1c | Arm 3: Months 30-60 | Hemoglobin A1c will be assessed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. |
| CGM Mean Sensor Glucose | months 0-60 | CGM mean sensor glucose will be assessed prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. |
| CGM Glucose Management Indicator | Arm 3: Months 30-60 | The Glucose Management Indicator will be assessed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. |
| Parent Perceived CGM Benefits and Burdens | months 0-60 | CGM Benefits and Burdens scale is a validated survey exploring perceived benefits and burdens of CGM use. CGM Benefits and Burdens will be completed prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. Scoring of the CGM Benefits subscale ranges from 1 to 40 with higher scores reflecting greater perceived benefits. Scoring of the CGM Burdens subscale ranges from 1 to 40 with higher scores reflecting less perceived burden. |
| Parent Diabetes Technology Knowledge | Arm 3: Months 30-60 | A survey assessing diabetes technology knowledge will be developed. This survey will be completed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. Scores range from 0 to 100 with higher scores reflecting greater knowledge. |
| Child Diabetes-Specific Quality of Life | Arm 3: Months 30-60 | The Type 1 Diabetes and Life (T1DAL) is a validated survey assessing diabetes-specific quality of life. T1DAL will be completed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. Scores range from 0 to 100 with higher scores reflecting greater quality of life. |
| Child Emotional Distress Related to T1D | Arm 3: Months 30-60 | Problem Areas in Diabetes- Child Version (PAID-C) is a validated survey assessing emotional distress related to T1D. PAID-C will be completed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion). Scores range from 11 to 84 with higher scores reflecting greater emotional distress. |
| Child Diabetes Self-Management | Arm 3: Months 30-60 | The Diabetes Management Questionnaire (DMQ) is a validated survey assessing diabetes self-management. The DMQ will be completed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. Scores range from 0 to 100 with higher scores reflecting greater adherence to diabetes management. |
| Child Perceived CGM Benefits and Burdens | Arm 3: Months 30-60 | CGM Benefits and Burdens scale is a validated survey exploring perceived benefits and burdens of CGM use. CGM Benefits and Burdens will be completed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. Scoring of the CGM Benefits subscale ranges from 1 to 40 with higher scores reflecting greater perceived benefits. Scoring of the CGM Burdens subscale ranges from 1 to 40 with higher scores reflecting less perceived burden. |
| Episodes of Severe Hypoglycemia | Arm 3: Months 30-60 | The number of episodes of severe hypoglycemia will be assessed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. |
| Emergency Department Visits | Arm 3: Months 30-60 | The number of diabetes-related emergency department visits will be assessed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. |
| Hospital Admissions | Arm 3: Months 30-60 | The number of diabetes-related hospital admissions will be assessed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. |
| Episodes of Diabetic Ketoacidosis | Arm 3: Months 30-60 | The number of episodes of diabetic ketoacidosis will be assessed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. |
| Parent Diabetes-Specific Quality of Life | Arm 3: Months 30-60 | The Type 1 Diabetes and Life (T1DAL) is a validated survey assessing diabetes-specific quality of life. T1DAL will be will be completed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. Scores range from 0 to 100 with higher scores reflecting greater quality of life. |
| Parent Emotional Distress Related to T1D | Arm 3: Months 30-60 | Parents of Children (P-PAID) is a validated survey assessing emotional distress related to T1D. P-PAID will be completed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. Scores range from 15 to 96 with higher scores reflecting greater emotional distress. |
| Parent Diabetes Self-Management | Arm 3: Months 30-60 | The Diabetes Management Questionnaire (DMQ) is a validated survey assessing diabetes self-management. The DMQ will be completed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. Scores range from 0 to 100 with higher scores reflecting greater adherence to diabetes management. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Qualitative analysis of semi-structured interviews | Arm 1: Months 0-15 | Semantic content analysis will identify widely captured themes pertaining to diabetes technology education so as to prioritize content to include in curriculum development. |
| Child Weight Z-score | Arm 3: Months 30-60 | Weight Z-score for age will be assessed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. |
| TeKnO T1D: Parents Curriculum discrimination | Arm 2: Months 10-33 | Using classical test theory as our framework, the investigators will conduct an item analysis to assess the quality of the items and the overall test, including item discrimination. |
| TeKnO T1D: Parents Curriculum difficulty | Arm 2: Months 10-33 | Using classical test theory as our framework, the investigators will conduct an item analysis to assess the quality of the items and the overall test, including item difficulty. |
| Child BMI Z-score | Arm 3: Months 30-60 | BMI Z-score for age will be assessed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. |
| Child Height Z-score | Arm 3: Months 30-60 | Height Z-score for age will be assessed in Arm 3 prior to the curriculum start, upon completion of the TeKnO T1D: Parents curriculum, and 12 weeks after the curriculum completion. |
Countries
United States
Outcome results
None listed