Optimizing Self-Management Adherence and Glycemic Control in Older Teens With Type 1 Diabetes: The Teenwork Study

Joslin Diabetes Center

Status: Completed

Conditions: Type 1 Diabetes

Treatments: Behavioral: Text message reminders; Behavioral: Teenwork intervention

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT01892280

2012-11

R01DK095273 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

The purpose of this 18-month randomized controlled trial (RCT) is to find out if (1) a set of psychoeducational materials for teens with type 1 diabetes and (2) text message reminders to check blood glucose levels can help improve blood glucose levels in teens with type 1 diabetes.

Full description

Glycemic control deteriorates during adolescence as parents become less involved in teens' diabetes management and adherence declines. Thus, there is a need to improve adherence and glycemic control in mid to older teens with type 1 diabetes by strengthening the teens' self-efficacy for daily diabetes self-management to help prepare them for the transition between pediatric and adult care. This 18-month, multi-center RCT is designed to increase frequency of blood glucose monitoring and improve glycemic control in teens with type 1 diabetes through a behavioral intervention called Teenwork with or without text message reminders to check blood glucose levels.

We will implement and evaluate the Teenwork intervention and text message reminders to check blood glucose levels in a 2x2 factorial design in which 300 participants, across two sites, will be randomized to 1 of 4 groups: Teenwork, Text Message, Teenwork/Text Message, or Usual Care.

Participants in the Teenwork Group will meet with a research assistant during each study visit to review strategies for improving self-care, including self-management and self-advocacy, focusing on two areas: blood glucose monitoring and insulin administration. Participants in the Text Message Group will be instructed in the use of the text messaging system. They will receive 2-way text message reminders to check blood glucose levels at self-selected times and to reply by text message with blood glucose results. Participants in the Teenwork/Text Message Group will receive both the Teenwork intervention and the text message reminders (as described above). Participants in the Usual Care Group will receive the same intervention as the Teenwork/Text Message Group, but not until after 1 year.

Enrollment: 310 patients

Sex: All

Ages: 13 to 17 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Youth age 13-17 years

• Diagnosis of type 1 diabetes according to American Diabetes Association criteria

• Diabetes duration ≥6 months

• Daily insulin dose ≥0.5 units/kg

• A1c ≥6.5%and ≤11%

• Willingness to check blood glucose levels

• Cell phone with text messaging ability

• Clinic attendance

  1. At least one clinic visit at the clinical site in the previous 12 months
  2. Anticipated care at the clinical site for the duration of the study

• Fluency in English (reading, writing, and speaking) for child and parent/guardian

• Enrollment no later than December of the teen's senior year of high school

Exclusion criteria

• Pregnancy in the youth participant
• Significant developmental or cognitive disorder that would prevent full study participation
• Significant mental illness, defined by either major psychiatric disorder (e.g., diagnosed eating disorder, major psychoses) or inpatient psychiatric admission within the previous 6 months
• Failure to understand that the 2-way text messaging does NOT result in immediate response from a health care professional; this will be assessed at the time of informed consent/assent
• Participation in another intervention study within the 3 months prior to enrollment
• Other psychosocial, medical, or family issues, as assessed by the teen's pediatric team, that would prevent full study participation

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Factorial Assignment

Masking: None (Open label)

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310 participants in 4 patient groups

Teenwork Group

Experimental group

Description:

Teen/family will receive the Teenwork intervention at each quarterly study visit.

Treatment:

Behavioral: Teenwork intervention

Teenwork/Text Message Group

Experimental group

Description:

Teen/family will receive the Teenwork intervention at each quarterly study visit. Teen will receive text message reminders to check blood glucose levels at self-selected times.

Treatment:

Behavioral: Teenwork intervention

Behavioral: Text message reminders

Text Message Group

Experimental group

Description:

Teen will receive text message reminders to check blood glucose levels at self-selected times.

Treatment:

Behavioral: Text message reminders

Usual Care Group

No Intervention group

Description:

Teen/family will receive routine clinical care for the first year of the study (the time period for assessment of primary outcomes). After year 1, teen/family will receive the Teenwork intervention at each remaining study visit and teen will receive text message reminders to check blood glucose levels at self-selected times.