Psychosocial and behavioral interventions (interventions with psychological, educational, behavioral change, and peer support components) can support individuals living with type 1 diabetes (T1D) to attain their best health and wellness outcomes. Yet, even when new interventions are successful in clinical trials, it is notoriously challenging to implement and sustain them in the busy clinical settings where patients receive their routine T1D care. The objective of this proposal is to learn how to translate evidence-based psychosocial and behavioral interventions into routine care where they will support people living with T1D. The research strategy proposes combining scientific methodology from the fields of implementation science, quality improvement, and precision medicine in a translational ëpipelineí. The early pipeline swiftly implements new evidence-based within routine care, while the latter part rigorously tests how well they work and for whom. The use case to test the pipeline will focus on diabetes distress in adults with T1D. Aim 1 will build infrastructure for screening and to offer two virtual interventions for treatment. Aim 2 will identify the most effective and minimally burdensome to screen for DD and initiate its treatment in the clinic. Aim 3 will execute a pilot study to test the interventions, using a precision medicine design that will generate new data and algorithms to match future patients with elevated DD to an optimal, individualized intervention, based on their characteristics. This pipeline can be reused to transform type 1 diabetes care, at scale, by translating other evidence-based psychosocial and behavioral interventions in clinical settings.
What area of diabetes research does your project cover? What role will this particular project play in preventing, treating and/or curing diabetes?
The day-to-day management of type 1 diabetes demands much more of patients than simply insulin dosing and glucose monitoring. A fundamental aspect of comprehensive and person-centered type 1 diabetes care includes addressing the complex social, emotional, behavioral, and environmental factors that affect both mental and physical health of people living with diabetes. Psychosocial and behavioral interventions (i.e., interventions with psychological, educational, behavioral change, and peer support components) can address the burdensome nature and emotional toll of day-to-day type 1 diabetes management, offering critical support for individuals living with type 1 diabetes to attain their best health and wellness outcomes. Yet, even when new interventions are successful in clinical trials, they are often time- and resource-intensive, and it is notoriously challenging to implement and sustain them in the busy clinical settings where patients receive their routine T1D care. The objective of this ADA Pathway project is to learn how to translate evidence-based psychosocial and behavioral interventions into routine care where they will support all people living with type 1 diabetes. This project will build a scientific pipeline to translate promising evidence-based psychosocial and behavioral interventions from research settings into clinical care; the early pipeline swiftly implements new evidence-based within routine care, while the latter part rigorously tests how well they work and for whom. As a specific use case with which I will build and test the pipeline, we will focus on screening for and addressing diabetes distress, which is a psychosocial issue that is prevalent among adults with type 1 diabetes, does not self-resolve, but is responsive to intervention. (Care guidelines from the American Diabetes Association recommend screening for and promptly addressing diabetes distress when it is detected.) Over the five years of funding, this project will implement and integrate evidence-based psychosocial screening and treatment options as part of routine type 1 diabetes care and generate the data that are critically needed to sustain them over timeóhow to target or tailor them to individual patientsí unique needs. Our goal is that this work will transform type 1 diabetes care in the future such that existing and emerging psychosocial and behavioral interventions can be more rapidly streamlined within routine practice and individualized to meet patients needs.
If a person with diabetes were to ask you how your project will help them in the future, how would you respond?
Living with type 1 diabetes is not easy, and it often takes a mental and emotional toll on individuals. Even when new interventions are shown to help people with diabetes in clinical trials by supporting these complex social, emotional, and behavioral aspects of managing diabetes every day, they are often not embedded within clinical care at scale and thus never made accessible to the large number of patients who may benefit. We want to change this by learning how to move the interventions that were successful in clinical trials to the clinic, our project will ensure that people living with type 1 diabetes have access to the comprehensive support they need to achieve their best possible health and wellness. Further, we know that each person living with type 1 diabetes is different, and the same intervention will not benefit everyone. We therefore aim to generate new scientific evidence that can be used to match individual patients with specific care and support plans that addresses their unique needs//from which they are most likely to benefit.
Why is it important for you, personally, to become involved in diabetes research? What role will this award play in your research efforts?
I understand, both professionally and personally, that psychological wellbeing is foundational for reaching treatment goals in type 1 diabetes, and interventions that support behavioral and psychosocial aspects of living with diabetes are a critical aspect of providing comprehensive, person-centered type 1 diabetes care. Thanks to the commitment and work of those who precede me, I believe we already have a robust evidence base with which to improve care, and particularly psychosocial and behavioral care -- it just hasnít been tapped to its full potential. The Pathway award will allow me to try and contribute my own intellect, creativity, and team skills to develop a new paradigm to translate what we know works to each patient who needs it. My long-term objective is to advance the field towards an integrated (i.e., embedded within routine care without burdening individual providers), individualized (i.e., responsive to interindividual differences), and data-driven (i.e., able to use patient data to select optimal interventions) model of delivering psychological and behavioral health as part of routine type 1 diabetes care. As a scientist, I have had the opportunity to train in a variety of different research methods, and my career goal is to bridge tools from across fields to address the complexity of diabetes management and tangibly improve outcomes for people living with diabetes. One of the most exciting aspects of the Pathway project is the way in which we will bring together methods from cutting-edge statistical, clinical, behavioral, and implementation science to advance the field. The Pathway award will also allow me to learn how to build and lead teams that will transform diabetes care for the future. Throughout the project, we will also engage and work closely with diverse stakeholders (including people living with type 1 diabetes) and use their input to iterate our science and ensure that the work we do remains feasible and relevant to the needs, priorities, and constraints of patients, clinicians, and clinics in everyday life.
In what direction do you see the future of diabetes research going?
Precision medicine is a field of science and medicine that aims to match the right treatment to the right patient at the right time. The American Diabetes Association Precision Medicine in Diabetes Initiative (PDMI) has already highlighted tremendous opportunities for precision medicine in diabetes, as well as a vision for person-centered, equitable, clinic-based, and streamlined precision diabetes medicine. I believe that the challenge and the opportunity for diabetes precision medicine will be to optimize clinical and patient-centered outcomes in the context of routine careóthis is where patients are most complex and their interindividual differences are greatest. Undertaking this Pathway project is a first step towards a larger vision for precision diabetes medicineó one that first implements our most cutting-edge psychosocial and behavioral care strategies at the system-level and then leverages statistical precision medicine tools for clinical decision support to empirically individualize their delivery, so each intervention remains resource-efficient, clinically-effective, and minimally-burdensome in routine care. My goal is to advance the field of diabetes precision medicine by develop a paradigm of precision medicine that improves the quality of diabetes care, with tangible impacts for most, while balancing the operational constraints that patients, providers, and institutions face daily.