Research Description
Adolescents with type 2 diabetes are frequently from historically disadvantaged racial/ethnic groups, disproportionately face social adversities, and have high rates of elevated depression symptoms and diabetes distress, which compromise treatment by undermining adherence to medication and lifestyle behavior recommendations, such as healthy diet, physical activity, and sleep. About 50% of adolescents with type 2 diabetes have trouble managing their blood sugar levels. Over time, blood sugar values that are not well-managed can lead to long-term health complications, such as cardiovascular disease. The proposed research is highly relevant to public health, because the identification of feasible, relatively brief, and potentially cost-effective interventions to address depression symptoms and diabetes distress in adolescents with type 2 diabetes offers the prospect of increasing treatment adherence, improving management of blood sugar levels, and consequently, mitigating the risk of health complications and earlier mortality. The proposed research will gather input from key stakeholders in youth-onset type 2 diabetes to tailor an existing evidence-based adolescent depression intervention called interpersonal psychotherapy (IPT) to address the unique social stressors that impact depression and type 2 diabetes management. The proposed research will also evaluate whether this adapted interpersonal psychotherapy program for adolescents with depression and type 2 diabetes (IPT-T2D) is feasible and acceptable to deliver in a pediatric healthcare clinic where adolescents with type 2 diabetes receive their specialty medical care. Finally, the proposed research will describe whether IPT-T2D is related to improvements in social relationships, depression, diabetes distress, medication adherence, lifestyle behaviors, and management of blood sugar levels.Research Profile
What area of diabetes research does your project cover? What role will this particular project play in preventing, treating and/or curing diabetes?This project focuses on mental health concerns in youth-onset type 2 diabetes (T2D). Mental health concerns, especially depression, may make it difficult for youth with T2D to maintain glycemic control, likely due to a combination of inadequate treatment adherence and stress-related physiology. The main objective of this project is to treat depression to improve glycemic control in youth with T2D. We hope to accomplish this objective by (1) adapting an existing evidence-based youth depression intervention – group-based interpersonal psychotherapy – to address the unique interpersonal relationship stressors faced by youth with T2D and (2) pilot testing its delivery, compared to a group-based standard T2D education program, in an existing pediatric T2D clinic, all via telehealth.
If a person with diabetes were to ask you how your project will help them in the future, how would you respond?This project aims to help youth with T2D improve their interpersonal relationships, mental health, diabetes treatment adherence, and ultimately, glycemic control. More specifically, we hope that a group-based mental health intervention that teaches interpersonal skills, such as communication and problem-solving, will help youth with T2D get more support and manage conflict better in their interpersonal relationships, especially in situations that specifically involve managing their diabetes. We also hope that this intervention will improve their mental health and make it easier to follow their diabetes treatment regimen and maintain glycemic control. Finally, we hope that integrating this group-based mental health intervention within a familiar and trusted pediatric T2D clinic and offering sessions via telehealth will increase access and engagement for youth with T2D.
Why important for you, personally, to become involved in diabetes research? What role will this award play?I am a pediatric psychologist whose research and clinical interests center on youth depression and anxiety, lifestyle behaviors, stress-related physiology, and cardiometabolic health concerns, especially youth-onset T2D. In addition to my research, I provide direct clinical services to youth with T2D in our hospital’s interdisciplinary pediatric T2D clinic. It is important for me to be involved in this area of research because youth-onset T2D is a worsening public health concern that disproportionately affects youth and families facing multiple social determinants of health, major life stressors, and mental health concerns. This award will fund a critical next step in youth-onset T2D care; to adapt and pilot test an accessible, acceptable, and evidence-based mental health intervention to improve glycemic control. After this project, we hope to test the efficacy of this mental health intervention in a subsequent, fully-powered, multisite trial.
In what direction do you see the future of diabetes research going?Mental health concerns in youth-onset T2D have received some attention in the literature, including the relationships among depression, medication adherence, and disordered eating, but there are many opportunities for future directions! I am optimistic that youth-onset T2D research will catch up to the robust body of research on mental health concerns and interventions for other pediatric health populations, such as type 1 diabetes. Youth-onset T2D and type 1 diabetes share many overlapping features, as do youth-onset T2D and adult-onset T2D. However, youth-onset T2D has unique characteristics (e.g., disease onset mostly in puberty, significant family history, possible presentation with no to mild symptoms, to name a few). Future research that explores the unique needs of youth with T2D has the potential to optimize not only mental health, but also physical health outcomes for this growing pediatric population.