Design and development of a stepped-care behavioral intervention to support parents of young children newly diagnosed with type 1 diabetes

Practical and Effective Mentorship Strategies for Caregivers of Children with Chronic Conditions: A Scoping Review

Caregivers of children with chronic conditions face daily challenges and a lower quality of life, which may be improved through peer support. This scoping review explored the literature on formal caregiver-to-caregiver mentorship programs, identifying strategies to inform future programs. Using Arskey and O'Malley's framework, we searched five databases for peer-reviewed literature on caregiver-to-caregiver mentorship programs for adult caregivers caring for children (≤18 years) with chronic conditions. Thematic analysis was performed on relevant articles. Of the 10 064 search hits, 109 were included after full-text screening. Theme 1, "Mentorship adds to medical support", reflected how mentorship can complement medical care provided by healthcare teams. Theme 2, "Successful mentorship requires the right mentors", highlighted the qualities of mentors crucial for effective mentorship, mentor-matching practices, and training areas for mentors. Theme 3, "Mentorship programs should balance structure and flexibility", emphasized the importance of allowing for flexibility to accommodate diverse family needs. Theme 4, "Mentorship programs face common challenges", summarized the challenges frequently faced when implementing mentorship programs. The study findings suggest that the success of mentorship programs hinge on factors including a flexible program structure, knowledgeable and dedicated mentors, and an infrastructure in place for supporting both the mentors and the financial needs of the program.

Experiences of Parent Coaches in an Intervention for Parents of Young Children Newly Diagnosed with Type 1 Diabetes

OBJECTIVES

This paper explores parent coaching experiences supporting parents of young children newly diagnosed with type 1 diabetes in a clinical trial.

METHODS

In a trial for 157 parents, those in the intervention arm (n = 116) were paired with a parent coach (n = 37; Mage = 37.9 years, SD = 3.9; 94.6% mothers, 81.1% White non-Hispanic). Parent coaches provided diabetes-specific social support. Parent coaches completed monthly surveys and satisfaction/feasibility surveys, with a subset (n = 7) undergoing qualitative interviews at the end of this study.

RESULTS

There were 2262 contacts between participants and their parent coaches, averaging 14.4 (SD = 9.3) per participant. Parent coaches reported that the most commonly used methods were text messages (67.9%) and emails (18.7%), with 33.6% having in-person visits. Coaches reported high satisfaction and belief in their usefulness to participants during the first 9 months after T1D diagnosis. Themes discussed by parent coaches about their experience in mentoring included relationship building, expertise sharing, personal growth, gratification, and intervention optimization suggestions.

CONCLUSIONS

Parent coaching post T1D diagnosis involves regular, multi-method contacts. It is highly acceptable and valuable for parent coaches to mentor other parents of young children newly diagnosed with T1D.

Randomised controlled trial of the Healthy Living Triple P-Positive Parenting Program for families of children with type 1 diabetes

This randomised controlled trial examined the efficacy of a brief, group-based parenting program in improving child and family outcomes for families of children with type 1 diabetes. Families (N = 50) of children (2-10 years) with type 1 diabetes were randomly allocated to intervention (n = 22) or care-as-usual (n = 28). Assessments (pre-intervention, post-intervention and 6-month follow-up) evaluated parent- and child-reported parenting behaviour, child behaviour/adjustment and child quality of life (primary outcomes); and metabolic control (routinely-collected blood glucose data), parents' self-efficacy with diabetes management, diabetes-specific child behaviour difficulties, family quality of life, parents' diabetes-related and general parenting stress and observed parent and child behaviour (secondary outcomes). Intent-to-treat analyses indicated greater rate of improvement over time for families allocated to intervention compared to care-as-usual for use of corporal punishment (primary caregivers only), and confidence with managing children's emotions/behaviours, parent-rated child quality of life and adjustment to the child's illness (secondary caregivers only). There were no other intervention effects. Although families found the intervention useful, low levels of psychosocial problems at baseline limited the scope for group-level improvement and there was limited evidence for intervention efficacy. Individually-tailored measures of goal-specific behaviour change may be considered in future research.

Satisfaction With Participation in the First STEPS Behavioral Intervention: Experiences of Parents of Young Children With Newly Diagnosed Type 1 Diabetes

OBJECTIVE

Parents of young children with new-onset type 1 diabetes (T1D) often experience significant distress and struggle with T1D management during a challenging developmental stage. The First STEPS (Study of Type 1 in Early childhood and Parenting Support) trial evaluated a stepped-care behavioral intervention comprising increasingly intensive intervention steps (peer parent coach, cognitive-behavioral counseling, consultations with diabetes educator and psychologist) based on need. The intervention improved parental depressive symptoms compared to usual care. Subsequently, we examined parent satisfaction with the intervention to guide potential implementation and refinement for future trials.

METHODS

Participants were 157 parents of young children newly diagnosed with T1D. At 9 months post randomization, n = 153 completed satisfaction questionnaires and n = 17 completed qualitative interviews. Satisfaction ratings about trial procedures and each intervention step were summarized. We used thematic analysis with the interview transcripts to generate themes related to participants' experiences in the trial overall and intervention specifically. We explored differences in themes between participants who did versus did not respond to the intervention and among those who experienced different intervention steps.

RESULTS

Most participants in both arms rated study participation and methods positively (>95%), and those completing interviews described high satisfaction with study procedures overall, retention incentives, and contact with study staff. Intervention participants' satisfaction ratings were high across steps. Two qualitative themes reflected satisfaction with the intervention enhancing self-efficacy and social support.

CONCLUSIONS

High satisfaction suggests implementing a stepped-care behavioral intervention as part of routine clinical care following T1D diagnosis would be well received.

Parent Perspectives of School/Daycare Experiences in Young Children Newly Diagnosed With Diabetes

OBJECTIVE

A central part of family adjustment to a new diagnosis of type 1 diabetes (T1D) is integrating T1D management into the child's school/daycare. This may be particularly challenging for young children who rely on adults for their diabetes management. This study aimed to describe parent experiences with school/daycare during the first 1.5 years following a young child's T1D diagnosis.

METHODS

As part of a randomized controlled trial of a behavioral intervention, 157 parents of young children with new-onset (<2 months) T1D reported on their child's school/daycare experience at baseline and at 9- and 15-month post-randomization. We used a mixed-methods design to describe and contextualize parents' experiences with school/daycare. Qualitative data were collected via open-ended responses, and quantitative data were collected from a demographic/medical from.

RESULTS

While most children were enrolled in school/daycare at all time points, over 50% of parents endorsed that T1D affected their child's enrollment, rejection, or removal from school/daycare at 9 or 15 months. We generated five themes related to parents' school/daycare experiences: Child factors, Parent factors, School/Daycare factors, Cooperation between Parents and Staff, and Socio-historical factors. Parents of younger children and those with lower subjective socioeconomic status were significantly more likely to endorse challenges with school/daycare enrollment.

CONCLUSIONS

School/daycare settings present challenges for parents of young children with T1D. Changes may need to occur across contexts to support early childhood education, including advocacy resources for parents to navigate school policies, increased training for school staff, and healthcare team outreach initiatives to parents and schools.

The relationship between atopic dermatitis and atopic itch in children and the psychosocial functioning of their mothers: A cross-sectional study

Atopic dermatitis is a chronic inflammatory skin disease significantly affecting patients' and their parents' lives. Mothers are mostly responsible for the long-term treatment and their wellbeing is essential. The major objective of this cross-sectional study was to investigate the relationship between atopic dermatitis in children, especially concomitant itch, and the quality of life, stress, sleep quality, anxiety, and depression of their mothers. The study included 88 mothers of children with atopic dermatitis and 52 mothers of children without atopic dermatitis. All mothers completed sociodemographic questionnaire, the Perceived Stress Scale, the Athens Insomnia Scale and the Hospital Anxiety and Depression Scale. Additionally, mothers of children with atopic dermatitis filled in the Family Dermatology Life Quality Index. The severity of atopic dermatitis and pruritus intensity were evaluated by the Scoring Atopic Dermatitis Index and the Numerical Rating Scale, respectively. The severity of atopic dermatitis and itch significantly correlated with the quality of life, insomnia, and perceived stress of the mothers. Mothers whose children had had atopic dermatitis for more than 6 months had significantly higher scores of anxiety and depression. The results highlight the importance of screening mothers for functional impairment to provide adequate support. More attention should be directed to the standardization of stepped care interventions addressing factors resulting in the impaired functioning of mothers.

Parents of children with congenital heart defects during the COVID-19 pandemic: An examination of mental health variables, risk factors, and protective factors

BACKGROUND

Little is known about the mental health burden or the factors that contribute to mental health variables in parents of children with congenital heart defects (CHD) during the COVID-19 pandemic.

OBJECTIVE

The purpose of this study was to examine risk and protective factors associated with anxiety symptoms, depression symptoms, and perceived stress in parents of young children with CHD during the COVID-19 pandemic.

METHODS

A nonexperimental design was used in this study of 127 parents of children aged newborn to five years with CHD during the COVID-19 pandemic. Regression analyses were conducted to examine associations between COVID-19 stressors, CHD care-related factors, parental resilience, external support, and mental health variables.

RESULTS

Parental resilience, emotional support, and informational support were key protective factors for anxiety, depression, and stress. However, resilience was remarkably low in CHD parents. Increased levels of anxiety symptoms, depression symptoms, and perceived stress were associated with 1) Exposure to a greater number of COVID-19-related stressors, 2) Distress from family visitation restrictions during healthcare encounters, 3) Worry related to the perceived risk of their CHD child's exposure to COVID-19 during healthcare encounters, and 4) Worry about their CHD child's risk of death or serious illness from COVID-19.

CONCLUSIONS

The additive impact of the COVID-19 pandemic plus CHD care-related worries on this parent population's mental health is significant. Interventions that promote resilience, address the effect of healthcare system changes, and support the needs of parents of young children with CHD during this and future pandemics are needed.

First STEPS: Primary Outcomes of a Randomized, Stepped-Care Behavioral Clinical Trial for Parents of Young Children With New-Onset Type 1 Diabetes

OBJECTIVE

Despite the emotional challenges of parental adjustment to a child's type 1 diabetes diagnosis and the unique complexities of early childhood, there are few programs designed to meet the needs of parents of young children at new onset. This study evaluated First STEPS (Study of Type 1 in Early childhood and Parenting Support), a stepped-care behavioral intervention designed to support parents' psychosocial functioning and promote children's glycemic outcomes.

RESEARCH DESIGN AND METHODS

Using a two-site randomized clinical trial design, parents (n = 157) of children aged 1-6 years completed baseline data within 2 months of diabetes diagnosis and were randomly assigned to intervention (n = 115) or usual care (n = 42) for 9 months. Intervention steps included: 1) peer parent coaching, with step-ups to 2) structured behavioral counseling and 3) professional consultations with a diabetes educator and psychologist, based on parent mood and child HbA1c. Participants completed follow-ups at 9 and 15 months postrandomization. Primary outcomes were parent depressive symptoms and child HbA1c.

RESULTS

Depressive symptoms improved in both groups, and intervention parents had significantly lower depressive symptoms at the 9- and 15-month follow-ups compared with usual care. HbA1c decreased in both groups, but there were no between-group differences at 9 or 15 months.

CONCLUSIONS

First STEPS improved parents' mood following young children's type 1 diabetes diagnosis. Results indicate likely benefits of parent coach support, supplemented by intervention intensifications, including behavioral intervention and diabetes education. This model has high potential for patient engagement. The absence of a medical intervention component may explain null findings for HbA1c; incorporating targeted behavioral support for intensive diabetes treatment may maximize intervention impact.

Development and delivery of a brief family behavioral intervention to support continuous glucose monitor use in young children with type 1 diabetes

BACKGROUND

Despite potential glycemic benefits of continuous glucose monitor (CGM) use in young children with type 1 diabetes, psychosocial and behavioral challenges may interfere with sustained use. We developed a 5-session family behavioral intervention (FBI) to support CGM use.

OBJECTIVE

We report on the multi-step development of the FBI, training interventionists, implementation in a 14-site clinical trial, and participant satisfaction.

METHODS

A multidisciplinary team created the FBI based on mixed-methods (i.e., survey data, qualitative research) preliminary work with parents of young children. Investigators trained non-physician staff to deliver the 5 sessions per an intervention manual. Trial participants received the FBI either during the first (FBI group, n = 50) or second 6-months (Crossover group, n = 44) of the 1-year trial. Investigators listened to session recordings to rate intervention fidelity, and participants rated satisfaction with the FBI.

RESULTS

The complete 5-session FBI was delivered to 89% of participants, in-person (73%) or by telephone (23%). Sessions lasted 23 min on average, and fidelity was high across sessions. Over 80% of participants rated very high satisfaction with all aspects of the FBI and offered few recommendations for improvement.

CONCLUSIONS

Having been developed based on experiences and input of families of young children with type 1 diabetes, the FBI represented a novel behavioral approach to enhance sustained CGM use during a challenging developmental period. Evidence of strong feasibility and acceptability supports its potential for implementation in research and clinical care. As diabetes technologies evolve, the FBI may continue to be refined to address parents' most relevant concerns.

Clinically elevated parent depressive symptoms and stress at child type 1 diabetes diagnosis: Associations with parent diabetes self-efficacy at 18-months post-diagnosis

OBJECTIVE

Eighteen percent of new diagnoses of type 1 diabetes (T1D) occur in children ages 9 and younger, and the burden of diabetes management in young children predominantly falls on parents. Despite the significant amount of information parents must learn and implement quickly after diagnosis, little research has examined diabetes self-efficacy in parents of young children soon after diagnosis in a longitudinal manner. The current study examined changes in parent diabetes self-efficacy over time, and parent depressive symptoms and stress soon after child T1D diagnosis as predictors of parent diabetes self-efficacy at 12- and 18-months post-diagnosis.

RESEARCH DESIGN AND METHODS

One hundred fifty-seven primary caregivers (91.7% female, 62.2% White, Non-Hispanic) of young children (M_age  = 4.47 ± 1.65 years, 54.8% female, 60% White, Non-Hispanic) were recruited within 2 months of their child's T1D diagnosis from two pediatric hospitals in the United States as part of a randomized clinical trial. Parents self-reported on their diabetes self-efficacy, depressive symptoms, and stress and at baseline (M_days since diagnosis = 29) and on parent diabetes self-efficacy again 12- and 18-months post-diagnosis.

RESULTS

Parent diabetes self-efficacy significantly improved from baseline to 12-months and 18-months post-diagnosis (p < 0.05). Parents exhibiting clinically elevated levels of depressive symptoms and stress at baseline had significantly lower parent diabetes self-efficacy 12- and 18-months post-diagnosis compared to parents with normal levels of depressive symptoms and stress.

CONCLUSIONS

Brief interventions for parents with clinically elevated depressive symptoms and stress soon after their child's diagnosis may improve parents' diabetes self-efficacy and ultimately support the management of their child's diabetes.

Up all night? Sleep disruption in parents of young children newly diagnosed with type 1 diabetes

BACKGROUND

Despite the known challenges of parental adjustment to new-onset type 1 diabetes (T1D) in young children, little is known about parental sleep soon after diagnosis.

METHODS

Parents (n = 157) of young children (4.5 ± 1.6 years) with new-onset T1D (29 ± 15 days) self-reported their sleep (Pittsburgh Sleep Quality Index, PSQI) at the baseline of a behavioral randomized control trial. We examined sleep patterns and relations with continuous glucose monitor (CGM) use.

RESULTS

Over two-thirds (68.8%) reported poor sleep quality (PSQI > 5, M = 8.3 ± 4.1). The mean reported sleep duration was 5.9 ± 1.4 h/night. PSQI scores did not significantly differ by CGM use.

CONCLUSIONS

Sleep disruption is a pervasive self-reported problem among parents of young children emerging early after the T1D diagnosis. Healthcare providers should discuss parental sleep as part of diabetes care soon after diagnosis. Further interventions targeting parental sleep may be of benefit.

Correlates and Patterns of COVID-19 Vaccination Intentions among Parents of Children with Type 1 Diabetes

OBJECTIVE

To examine psychosocial, sociodemographic, medical, and coronavirus disease 2019 (COVID-19) experiences as correlates of COVID-19 vaccination intentions among parents of children with type 1 diabetes (T1D).

METHODS

121 parents of children with T1D (Mchild age = 7.78 ± 1.70; MA1c = 8.3% ± 1.5%) in the mid-Atlantic and Southwest regions completed self-report measures in February to March 2021.

RESULTS

Parents' general vaccination behaviors and attitudes were associated with COVID-19 vaccination intentions. Child insurance type and social distancing adherence were associated with vaccination intention in the Southwest site. Higher A1c was associated with lower intention. Vaccine safety was the top reported concern.

CONCLUSIONS

COVID-19 vaccination intentions are important to address in parents of youth with health conditions.

Young Children with Type 1 Diabetes: Recent Advances in Behavioral Research

PURPOSE OF REVIEW

This review provides a recent update of behavioral research pertinent to young children with T1D and addresses current priorities and future directions.

RECENT FINDINGS

Rates of type 1 diabetes (T1D) in young children (ages 1-7) are continuing to rise. Since 2014, changes to diabetes care and management have impacted young children and reinforced the need for increased attention and interventions to support diabetes management, especially in caregivers who are primarily responsible for their young child's diabetes management. T1D is associated with unique physiologic challenges in young children, with constant management demands elevating parental diabetes-related stress and fear of hypoglycemia. Diabetes technology use has significantly increased in young children, contributing to improvements in glycemic levels and parent and child psychosocial functioning. Yet despite the positive outcomes demonstrated in select clinical behavioral interventions, research with this young child age group remains limited in scope and quantity.

"All these people saved her life, but she needs me too": Understanding and responding to parental mental health in the NICU

OBJECTIVE

To explore the mental health needs of parents of infants in a neonatal intensive care unit (NICU), as well as barriers and solutions to meeting these needs.

DESIGN

Qualitative interviews conducted with parents and staff (n = 15) from a level IV NICU in the Northwestern United States. Thematic analysis completed using an inductive approach, at a semantic level.

RESULTS

(1) Information and mental health needs change over time, (2) Staff-parent relationships buffer trauma and distress, (3) Lack of continuity of care impacts response to mental health concerns, (4) NICU has a critical role in addressing parental mental health.

CONCLUSION

Mental health support should be embedded and tailored to the NICU trajectory, with special attention to the discharge transition, parents living in rural areas, and non-English-speaking parents. Research should address structural factors that may impact mental health such as integration of wholistic services, language barriers, and staff capacity.

Patterns of Continuous Glucose Monitor Use in Young Children Throughout the First 18 Months Following Type 1 Diabetes Diagnosis

Objective: To describe sociodemographic and parent psychosocial characteristics associated with patterns of continuous glucose monitor (CGM) use across the first 18 months post-type 1 diabetes (T1D) diagnosis among young children. Methods: One hundred fifty-seven parent-child dyads enrolled in a behavioral intervention for parents of young children (1-6 years) newly diagnosed with T1D. Parents reported on baseline sociodemographic characteristics and psychosocial functioning; child CGM use was assessed at five time points during the first 18 months post-diagnosis. Results: Most participants (81.8%) used CGM at least once. Four CGM trajectories emerged (always, later/stable, inconsistent, and never). Participants with private insurance were more likely to be in the always, later/stable, or inconsistent groups versus the never group. Youth in the always and later/stable groups had lower mean HbA1c at 18 months than those in the never group. Conclusions: Given the health benefits of CGM, further exploration of barriers to CGM use in families with public health insurance is needed. ClinicalTrials.gov identifier: NCT02527525.

Predictors of mood, diabetes-specific and COVID-19-specific experiences among parents of early school-age children with type 1 diabetes during initial months of the COVID-19 pandemic

OBJECTIVE

The current study explored pre-pandemic sociodemographics, medical characteristics, social/family support, and mood symptoms, and current COVID-19 experiences as predictors of mood, positive/negative diabetes-specific experiences, and COVID-19-specific distress among parents of children with type 1 diabetes during the COVID-19 pandemic. We hypothesized that parents from marginalized backgrounds, youth with higher pre-pandemic A1c and no CGM use, parents with lower pre-pandemic social/family support and more pre-pandemic mood/anxiety symptoms, and those with more negative COVID-19 experiences would have more depressive symptoms, fewer positive and more negative diabetes-specific experiences, and more COVID-19-specific distress during the initial months of the pandemic.

RESEARCH DESIGN AND METHODS

Participants were parents of early school-age children with type 1 diabetes (n = 100; 65% non-Hispanic, white, 92% mothers, 75% married; M_{child age}  = 6.74 ± 1.59 years) who had completed a behavioral intervention trial ≥6 months ago and were re-contacted in June/July 2020 to report on their COVID-19 pandemic experiences and parent psychosocial outcomes. Pre-pandemic parent mood/anxiety symptoms, family/social support, and children's medical characteristics (CGM use; M_A1C  = 8.17% ± 1.40%) were assessed M = 1.45 ± 0.59 years prior.

RESULTS

More pre-pandemic social support predicted fewer depressive symptoms, more positive diabetes-specific experiences, and less COVID-19-specific distress during the pandemic. More pre-pandemic depressive symptoms predicted more depressive symptoms during the pandemic. More life disruptions due to the pandemic were associated with more negative diabetes-specific experiences and more COVID-19-specific distress. Parents of color had more negative diabetes-specific experiences.

CONCLUSIONS

Social support may be particularly important to assess and address through intervention. Pediatric diabetes care providers should monitor parent experiences in relation to children's diabetes management. ClinicalTrials.gov identifier: NCT02527525.

The Food Allergy Parent Mentoring Program: A Pilot Intervention

OBJECTIVE

Parents of young children with newly diagnosed food allergy (FA) are at risk for poor psychosocial outcomes due to FA's life-threatening nature and demanding management routines. Presently, there are no interventions to support FA parents during this adjustment phase. This single-arm pilot study explores the feasibility, acceptability, and preliminary efficacy of a novel intervention using peer mentorship to improve psychosocial functioning in parents of young children with newly diagnosed FA.

METHODS

Parent mentors were trained in mentorship and ethics and then matched with a mentee for a 6-month intervention period. Mentees, parents of children (under age 5 years) diagnosed with FA within 1 year, completed baseline and follow-up questionnaires to assess demographic and medical characteristics, FA knowledge, quality of life, self-efficacy, and social support and a program evaluation. Follow-up focus groups with mentors and individual interviews with mentees were conducted.

RESULTS

Participants were 8 mentors and 10 mentees (Mage = 36.60 years, 80% Caucasian) of children ages 0-3 years (Mage = 16.15 months; 60% male). Mentees reported high acceptability for the intervention in program evaluation and interviews, noting improvements in their social support, FA-related stress, confidence in FA management, and positive changes in FA parenting behaviors.

CONCLUSION

This study supports the use of a peer mentorship program to support parents of children with newly diagnosed FA. Future research is needed to determine how to scale this intervention to meet the needs of a large medical division.

Recruiting and retaining parents in behavioral intervention trials: Strategies to consider

OBJECTIVE

Recruitment and retention are paramount to the success of randomized controlled trials (RCTs); however, strategies and challenges to optimize recruitment and retention are often omitted from outcomes papers. The current manuscript presents strategies used to recruit and retain over 97% parents of young children newly diagnosed with type 1 diabetes for over 15-months post-randomization enrolled in First STEPS, a behavioral, two-site RCT.

METHOD

Participants included 157 primary caregivers of young children newly diagnosed with type 1 diabetes. Recruitment and retention strategies are described and include collaboration with medical teams, careful selection and training of study staff, inclusion of a behavioral run-in prior to randomization, financial incentives, creation of a study identity using retention items, obtainment of feedback from community stakeholders, and minimization of participant burden.

RESULTS

Use of recruitment and retention strategies resulted in enrollment of 58% of eligible and reached families, with retention of the enrolled sample above 97% for over 15 months. Participants reported high acceptability of and satisfaction with specific recruitment and retention strategies.

CONCLUSIONS

The strategies used to recruit and retain caregivers of young children newly diagnosed with a chronic illness were feasible to implement within multidisciplinary diabetes clinics and may apply to other pediatric populations. Future research may benefit from a focus on strategies to engage more diverse samples.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02527525.

Implementation and Preliminary Feasibility of an Individualized, Supportive Approach to Behavioral Care for Parents of Young Children Newly Diagnosed With Type 1 Diabetes

There are significant stressors related to parenting a young child with newly diagnosed type 1 diabetes (T1D). Despite these challenges, there are not yet clearly defined interventions to help promote psychological health and adherence for families with young children with T1D. First STEPS is a tailored stepped care design intervention to positively impact parents' emotional functioning and children's glycemic control in young children newly diagnosed with T1D. The First STEPS intervention is derived from a combination of Cognitive Behavioral Theory and Social Cognitive Theory to support family adjustment to T1D, promote parental mastery over T1D tasks, increase coping skills to manage stressors associated with T1D, and build on the strengths of families newly diagnosed with T1D to help them achieve positive health and wellbeing outcomes. We present details about the intervention and describe two pilot participants as case studies. Results indicated that the treatment and delivery model were acceptable to the pilot participants, as evidenced by treatment completion and satisfaction ratings. Future directions for this work include testing the efficacy of this new treatment in a randomized controlled trial.

Call the Coach: Opportunities and Challenges for Parent Coaching in Pediatric Type 1 Diabetes

Editor's Note: This article was adapted from the address Dr. Streisand delivered as the recipient of the American Diabetes Association's Richard R. Rubin Award for 2020. This award recognizes a behavioral researcher who has made outstanding, innovative contributions to the study and understanding of the behavioral aspects of diabetes in diverse populations. Dr. Streisand delivered the address in June 2020 at the Association's virtual 80th Scientific Sessions.

"I'm essentially his pancreas": Parent perceptions of diabetes burden and opportunities to reduce burden in the care of children <8 years old with type 1 diabetes

BACKGROUND

Across all age groups, management of type 1 diabetes (T1D) places substantial responsibility and emotional burden upon families. This study explored parent perceptions of the burdens of caring for very young children with T1D.

METHODS

Semi-structured qualitative interviews were conducted with parents (85% mothers) of 79 children with T1D, aged 1 to <8 years old, from four diverse pediatric diabetes clinical centers. Interviews were transcribed, coded, and analyzed using hybrid thematic analysis to derive central themes.

RESULTS

Youth (77% White) had T1D for ≥6 months: age (M ± SD) 5.2 ± 1.5 years, diabetes duration 2.4 ± 1.3 years, and A1c 63 ± 10 mmol/mol (7.9 ± 0.9%); 66% used an insulin pump and 61% used CGM. Three major themes emerged related to diabetes burdens: (a) the emotional burden of diabetes on themselves and their children, (b) the burden of finding, training, and trusting effective secondary caregivers to manage the child's diabetes, and (c) suggestions for how more comprehensive, personalized diabetes education from healthcare providers for parents and secondary caregivers could help reduce parent burden and worry.

CONCLUSIONS

In families with very young children with T1D, parental perceptions of the burden of managing diabetes are common and could be mitigated by tailored education programs that increase parent knowledge, bolster parents' confidence in themselves, and increase trust in their secondary caregivers to manage diabetes. Reduced parental burden and increased caregiver knowledge may positively impact child's glycemic control, as well as improve parent and child quality of life.

Type 1 Diabetes Mellitus in Pediatric Patients and Its Impact on Relationships in the Family Environment

PURPOSE

The aim of this study is to assess the impact of type 1 diabetes mellitus on family environment relationships, as well as the management and approach to this disease.

PATIENTS AND METHODS

One hundred one children, 52.47% male and 47.52% female, with an average age of 8.55 ± 4.01 years, diagnosis of type 1 diabetes mellitus. Quantitative cross-sectional descriptive study was conducted using the validated questionnaires "Modified Diabetes Quality of Life" and "Questionnaire for the assessment of psychological impact in parents/guardians of diabetic children".

RESULTS

Most of the children (70.3% versus 29.7%) identified diabetes as unpleasant or not fun. The ≤5-year-olds expressed that they felt concerned about the consequences of being diabetic (8.1% by age group), as opposed to the 10-year-olds who did not feel concerned (85.1% by age group), P <0.001. The family environment was affected in 98.1% (n=99) of the cases.

CONCLUSION

Self-care of type 1 diabetes mellitus in pediatric patients is a complex process that impacts the family environment and their relationship with their peers, especially for children under the age of 5. Fear, concern and insecurity were prevalent feelings in children suffering type 1 diabetes mellitus.

Diabetes camp still matters: Relationships with diabetes-specific distress, strengths, and self-care skills

OBJECTIVE

Prior studies suggest diabetes camps improve psychosocial well-being in youth with type 1 diabetes but these studies suffer from variable levels of rigor. The present study assessed associations between camp participation and diabetes distress, perceived independence in diabetes self-care, and diabetes strengths in a large sample of children, adolescents, and their parents across 44 camps in the United States. Analyses compared viewpoints of study participants, identified moderators of change, and assessed perceived benefits of camp participation.

METHODS

There were 2488 youth and 2563 parents consented for participation in the online survey. Participants reported diabetes distress and perceived independence in youth care, their new experiences and best parts of camp, and changes in behavior following camp. T-tests, regressions, Cohen's d, and relative frequencies were used as appropriate to assess baseline differences between reporters, pre-post outcome differences, and moderators of change.

RESULTS

Parents as compared to youth reported higher pre-camp distress and lower perception of youth independence in self-care. Youth experienced a statistically significant decrease in distress and increase in independence in self-care. Diabetes strengths did not change. Higher A1c prior to camp was associated with higher levels of distress across camp participation. Campers and their parents endorsed a high frequency of positive firsts, bests, and benefits of camp.

CONCLUSIONS

Data from a large sample youth with type 1 diabetes across multiple camps showed broad-based psychosocial benefits of camp participation.

Feasibility and pilot study of an intervention to support active lifestyles in youth with type 1 diabetes: The ActivPals study

BACKGROUND

Evidence suggests youth with type 1 diabetes (T1D) have lower levels of physical activity (PA) than the general population. The ActivPals intervention aimed to support youth with T1D to lead an active lifestyle.

METHODS

Twenty youth aged 7 to 16 years with T1D were recruited to a pilot randomized controlled trial. PA and quality of life (QoL) were measured using Actigraph GT3X+ monitor and Pediatric QoL scales at baseline and 1-month follow-up. A two-way, mixed ANOVA showed indicative effects of the intervention. Qualitative interviews were carried out with 16 participants to explore perceptions of the intervention.

RESULTS

An increase in moderate to vigorous PA was reported in intervention and control groups from baseline to follow-up (F(1, 14) = 5.83; P = .03), with no significance between group differences. Participants in both groups reported significantly less overall diabetes "problems" (F(1, 16) = 7.93; P = .012) and significantly less lifestyle "problems" (F(1, 16) = 7.39; P = .015) at follow-up. However, both groups also reported significant increases in "problems" with the day-to-day diabetes routine (F(1,16) = 6.48; P = .022) at follow-up. Parents reported significant increased worry about their child's diabetes at follow-up, in both groups (F(1, 14) = 5.83; P = .046). There was no significant increase in reported hypoglycemic occurrences despite increased PA. The qualitative data highlight that goal setting, self-monitoring, and social support were effective motivators for increasing PA.

CONCLUSIONS

A larger trial with longer follow-up should be conducted to explore the effect of the intervention on PA in youth with T1D.

Considering Culture: A Review of Pediatric Behavioral Intervention Research in Type 1 Diabetes

PURPOSE OF REVIEW

Type 1 diabetes (T1D) incidence in youth is growing across all racial/ethnic backgrounds, with the most marked increase in African-American youth under 5. Underrepresented racial/ethnic minorities are at an increased risk for health complications. This review focuses on the reported disparities, demographics of samples in behavioral interventions, and study design considerations.

RECENT FINDINGS

Recruitment data from two ongoing behavioral intervention trials for young children with T1D are presented to compare enrolled/non-enrolled individuals and to discuss culturally appropriate study design considerations. Data were compared to the demographics of children (ages 1-6) with T1D in the clinic populations from the recruitment sites. Enrolling a representative sample and designing culturally appropriate behavioral interventions are important for generalizability, yet there is a gap between the individuals participating in T1D research and those who are most negatively affected by T1D. Suggestions are offered for ways to expand inclusion of diverse samples in behavioral intervention research in T1D.