Research Description
Teenagers with Type 1 Diabetes (T1D) experience high levels of diabetes-specific emotional distress. Distress leads to poor glycemic control and to worse psychological functioning. Our team created a program for teens (Supporting Teen Problem Solving; STePS) that showed it reduced distress. This program was studied under strict study conditions. Since most studies never get translated into real-world settings, and since our study showed promising results in reducing teen distress, we are proposing to assess whether this intervention can be successfully implemented in diverse diabetes programs across the country, and offered to all teens who are interested (instead of having strict study inclusion criteria) and provided by the behavioral health specialists already embedded in those diabetes programs (instead of provider by intensively study-specific trained interventionists). Many studies show promise, but never move to real-world settings or are never studied under real-world conditions. We believe that there is an urgent need to assess the STePS intervention in the real-world. This intervention is a group-based, teen-focused program that reduces diabetes distress and prevents worsening A1c’s. We propose studying both the effectiveness of the intervention in reducing distress and improving glucose control, as well as the potential for this intervention to be easily adapted by diabetes programs across the country. If we find that STePS is successful and is easily implemented into diabetes clinics, then we will be able to significantly impact the psychological and well-being of teenagers living with T1D and significantly impact their physical health as well.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?The project addresses diabetes-specific emotional distress in teenagers with T1D. This project will study an intervention we developed called: Supporting Teen Problem Solving (STePS), which is a group-based, teen-focused intervention aimed at reducing diabetes-specific emotional distress and building diabetes resilience. We studied this intervention in an ideal research environment with strict inclusion rules and highly trained interventionists. We found that it significantly reduces diabetes distress and builds resilience by improving emotion regulation, perspective-taking, adaptive problem-solving, and communication. STePS also prevented the expected worsening of glycemic outcomes over time. However, there is an urgent need to translate research-based interventions into real-world settings, and there is an unacceptable lag-time between efficacy trials and routine uptake of clinical interventions. Therefore, this current project will assess the STePS intervention with providers who are already integrated into the diabetes clinic setting and who would naturally implement STePS in a real world setting. In addition, STePS will be delivered using two models: in-person and telehealth. This increases the likelihood of disseminating STePS. Studying the effectiveness and implementation of STePS from diabetes centers across the country (we are recruiting from 6 centers) will allow us to understand issues related to adoption, feasibility, fidelity, and sustainability.
If a person with diabetes were to ask you how your project will help them in the future, how would you respond?I am hoping we find that this intervention is able to be implemented into all diabetes programs across the country. This will help teenagers have ready access to a program that increases their resilience and reduces their diabetes-related distress. This will help set teenagers on a positive trajectory towards improved mental and physical health.
Why important for you, personally, to become involved in diabetes research? What role will this award play?I have been involved in diabetes research for three decades. My clinical work with children, teenagers and their families has informed my research questions. I have been fortunate enough to obtain funding from different sources (ADA, JDRF, Helmsley and NIH), and I have been able to publish research articles from those funded projects. These projects have focused on issues such as improving self-management behaviors, family adaptation and coping, building adolescent resilience, the use of technology (CGM, Pumps and the Artificial Pancreas), and transitioning from pediatric to adult care. This award will help move a research program into actual clinical practice so that it is easily available to anyone who would benefit from it.
In what direction do you see the future of diabetes research going?Diabetes research has increasingly recognized the importance of assessing the psychosocial impact of diabetes on people who live with it and on those who love them. I am grateful for this increased recognition that diabetes research needs to not only focus on glycemic outcomes, but also focus on the psychosocial outcomes.