Diabetes Link Discord
Phase: NA
Conditions: Type 1 Diabetes
Sponsor: Children's Mercy Hospital Kansas City

Diabetes Link Discord 
June 27, 2024 

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PROTOCOL TITLE:  
Diabetes Link  Discord 
PRINCIPAL INVESTIGATOR: 
Mark Clements, MD, PhD 
Endocrinologist 
Pediatric Clinical Research Unit 
The Children’s Mercy Hospital 
2401 Gillham Road 
Kansas City, MO 64108 
Email: maclements@cmh.edu 
Phone: 816-983-6982 
 
IND/IDE NUMBER:  
 
VERSION NUMBER/DATE: 
Include the version number and date of this protocol. 
 
REVISION HISTORY 
 
This Revision History table is provided for the benefit of study team version control.  If 
this table will not be useful please delete it. 
 
Revision 
# 
Version Date 
Summary of Changes 
Consent 
Change? 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Table of Contents 
STUDY INFORMATION 
1.0 Study Summary 
2.0 Objectives 
3.0 Background 
4.0 Study Endpoints 
5.0 Study Design 
6.0 Study Interventions 
PARTICIPANT MANAGEMENT 
7.0 Inclusion and Exclusion Criteria 
8.0 Local Number of Participants 
9.0 Screening and Recruitment Methods 
10.0 Surveys and Psychometric Testing 
11.0 Additional Study Activities 
12.0 Follow-Up 
13.0 Genetic Analysis Information 
14.0 Sharing of Results with Participants 
15.0 Risks to Participants 
16.0 Potential Benefits 
17.0 Investigator Assessment of Risk/Benefits Ratio 
18.0 Payment, Reimbursement and Tangible Property Provided to Participants 
19.0 Compensation for Research-Related Injury 
20.0 Economic Burden to Participants 
21.0 Parental Permission and Adult Consent Process 
22.0 Assent of Pediatric Participants 
23.0 HIPAA and Confidentiality 
24.0 Provisions to Protect the Privacy Interests of Participants 
25.0 Withdrawal of Participants 
DATA MANAGEMENT 
26.0 Data Collection 
27.0 Adverse Events and Unanticipated Problems 
28.0 Statistical Analysis 
29.0 Data and Specimen Management 

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30.0 Storage/Banking of Data and Specimens for Future Research 
31.0 Provisions to Monitor the Data to Ensure the Safety of Participants 
DATA MANAGEMENT 
32.0 Settings and Locations 
33.0 Multi-Site Research 
34.0 International Research 
ADDENDUMS 
Addendum A: Waiver of Documentation of Permission/Consent 
Addendum B: Waiver/Alteration of Permission/Assent/Consent 
Addendum C: Non-English Speaking Participants 
Addendum D: Surrogate Decision Maker Consent 
Addendum E: Waiver/Alteration of HIPAA Authorization 
 
 
 

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STUDY INFORMATION 
1.0 
Study Summary* 
Study Title 
An Investigation of the Diabetes Link Discord Platform 
 
Study Design 
Single site, pilot, longitudinal 
Primary Objective 
To examine the feasibility and acceptability of the Diabetes 
Link’s online social platform Discord among youth with diabetes 
as it relates to peer support, diabetes management, and 
usability.  
Secondary Objective 
To examine the efficacy/magnitude of the effect of the Discord 
group on treatment adherence among youth with diabetes.   
Research Intervention(s) 
Participants will join the Children’s Mercy Discord group led by 
the nonprofit Diabetes Link. Participants will participate in live 
video gatherings, as well as posted chats/prompts, and will 
answer a few qualitative questions at the end of their 
participation. Discord user metrics--both quantitative and 
qualitative (deidentified transcripts/audio recordings)--and health 
record metrics will be analyzed in addition to the end survey.        
IND/IDE # 
N/A 
Study Population 
T1D patients in 11th and 12th grade (ages 16-19) who have access 
to a smartphone/laptop and speak English  
Sample Size 
Sample size for app use: 20 11th/12th graders  
 
Study Duration for 
Individual Participants 
Users will use Discord for 3 months.  
Study Specific 
Abbreviations/Definitions 
DL = Diabetes Link Nonprofit Organization 
T1D= type one diabetes 
T2D= type two diabetes 
Children’s Mercy Hospital Kansas City (CMH) 
Mobile Application (app or apps) 
Children’s Mercy- Kansas City (CMKC) 
 
 
 
 
2.0 
Objectives* 
2.1 
Purpose, specific aims or objectives:   
Aim 1: To examine the feasibility and acceptability of the Diabetes Link’s online 
social platform Discord among youth with diabetes as it relates to peer support, 
diabetes management, and usability. 

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Aim 2: To examine the efficacy/magnitude of the effect of the Happy Bob app on 
treatment adherence among youth with diabetes.   
2.2 
Hypothesis:  
Aim 1, Hypothesis: The intervention will be considered feasible, and patients will 
be satisfied with the Discord peer group, as assessed with enrollment rate, 
retention and refusal rates, attrition rate, usage, as well as perceptions of the 
format, organization, and content of the app, perceived impact on 
disease/treatment management, and satisfaction with the app. 
Aim 2, Hypothesis 1: Participants will demonstrate increased treatment 
engagement while participating in the Discord platform.  
Aim 2, Hypothesis 2: Participants who increase   
treatment engagement as a result of this intervention will experience better 
diabetes-related health outcomes.   
3.0 
Background* 
According to the CDC’s National Diabetes Statistics Report, 2020, approximately 
187,000 children and adolescents in the United States are living with type 1 
diabetes (T1D). Managing T1D among youth can be challenging and time 
consuming. It requires adherence to routine blood glucose monitoring, insulin 
administration as well as close attention to balancing physical activity and diet. 
Effective management of T1D in youth is key to good glycemic control. Attaining 
good control early in the course of T1D is important for reducing the risk of T1D-
related complications (e.g. metabolic memory; Chemtob et al., 2011; Ceriello, 
2012; Giordano et al., 2011; Pop-Busi et al., 2010 Silverstein et al., 2005;). Some 
children and families excel when faced with the challenges of T1D, while others 
struggle with their disease, as evidenced by declining glycemic control (Helgeson 
et al., 2010; Kia-Keating et al., 2011; Rausch et al., 2012). 
Improved engagement with treatment options (e.g. standard of care visits, peer 
mentoring, direct to consumer telehealth, digital therapeutics, etc.) will result in 
better glycemic control and will ultimately help reduce the risk of acute and 
chronic diabetes related complications. Furthermore, a review by Oser and 
colleagues found that “diabetes online communities have grown” and “enabled 
communities of peers to both seek and receive support for living with diabetes, 
providing an important supplement to what is provided in healthcare settings “ 
(2020). We would like to quantitatively and qualitatively evaluate the impact of 
these online communities.  
Our preliminary data—from focus groups, online events hosted by the Diabetes 
clinic, the clinic intake form, and ADA camp participation—highlights the desire 
among teens with T1 to connect with T1 peers. 
A Canadian internet-based study found that 65% of youth aged 14 to 24 years with T1D reported stigma 
related to the disease. In response, a Virtual Peer Network (VPN) was built to provide a forum for peer 

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relatedness and social support. The VPN examined the proportions of different types of exchanges and 
delineated the topic of importance to members. The study’s findings support the building of internet-
based peer communities for T1D and other chronic conditions as they constitute a valuable resource for 
chronic disease management. (Wu et al. 2023) 
 
The Canadian study found that “the ratio of comments, reactions, and views to posts were 3.6 to 1, 5.3 
to 1, and 57 to 1, respectively,” and that involvement increased with time. Comments were coded, and 
over 50% fit into social support categories (informational support, self-esteem support, etc). And 10 
themes emerged: (1) intersections of T1D and life (school, work, travel, driving); (2) relationships 
between glucose levels and habits (alcohol, etc); (3) T1D and social relationships; (4) stories about 
diagnosis, milestones, and identity; (5) self-management; (6) meeting and interacting with others with 
T1D; (7) experience with healthcare providers/health system; (8) T1D and society (policy issues, 
insurance); (9) technology, supplies, and materials; (10) T1D and public sphere (advocacy). This study 
provides support for the online content and metrics we will incorporate into our study, and it also 
highlights an area in which we can add value. This Canadian study did not query participants about the 
value the social network provided them, and this is something we certainly intend to do. Social 
support/confidence/etc is a contributor to diabetes management, and thus diabetes outcomes, and so 
we want to examine the value that social support brings, and also the effect that that value then brings 
to management and outcomes.  
 
4.0 
Study Endpoints N/A 
5.0 
Study Design* 
4.1 
Study Design: pilot, single site, longitudinal  
6.0 
Study Interventions* 
5.1 
Description: Describe the study intervention and/or experimental 
manipulation that is being evaluated. 
5.2 
Behavioral Intervention: If this study involves a behavioral intervention, 
describe the intervention in detail. Be sure to address whether the intervention is 
experimental or considered to be an accepted standard. 
The nonprofit organization Diabetes Link hosts an online Discord peer support server for young 
adults with Type 1 Diabetes. On the server, there are different channels for different topics 
(relationships, mental health, nutrition, etc). The Link has a library of resources called the 
Resource Hub (articles, worksheets, videos, etc) on various diabetes-related topics. The 
Diabetes Link has staff who monitor the server, host live online events, post conversation 
starters, and more to foster interaction among members. For this study, Diabetes Link will 
create a special server just for Children’s Mercy study participants for at least 3 months. The 
organization’s employees will not enroll Human Subjects or obtain the informed consent of any 
Human Subject for participation in the Research. A live video session will be held at the start to 
go over server etiquette, introductions, etc. Over the course of the 3 months, about 6 live video 
events will be held, hosted by Diabetes Link staff, allowing participants to interact. Events could 
be anything from watching a movie together, to informal chats, to question and answer 
sessions, etc. The DL staff will also make weekly posts for participants to respond to.   

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Employing the strategy of behavioral economics, up to 6 raffles will be held throughout the 
trial. Participants can earn a raffle entry for every 1 live event attended and/or for every 3 posts 
made. After 3 months of Discord use, participants will be asked a few survey questions about 
their experience.  
PARTICIPANT MANAGEMENT 
7.0 
Inclusion and Exclusion Criteria* 
6.1 
Eligibility Criteria:  
Inclusion Criteria 
•  T1D Diagnosis 
• 16-19 years old 
• 11th-12th graders 
• Access to smartphone/laptop 
• English-speaking (The Diabetes Link resources are only available in 
English)  
 
 
6.2 
Vulnerable Populations: Check any vulnerable populations that are being 
targeted for enrollment into the study: (Members of the following populations 
may not be included as participants in the research unless selected here.) 
☐ Children/Minors (under 7 years of age) 
☒ Children/Minors (7-17 years of age) 
☐ Neonates (infants less than 30 days old) 
☐ Neonates of Uncertain Viability (infants 
less than 30 days old) 
☐ Non-Viable Neonates (infants less than 
30 days old) 
☐ Wards of the State 
☐ Fetuses 
☐ Pregnant Women  
☐ Adults with impaired decision-making 
capacity         
☐ CM Employees 
☐ CM Students/Residents/ Fellows 
☐ Economically or Educationally 
Disadvantaged Persons 
☐ Prisoners 
 
 
This study will include children (<18 Y.O.), who are a vulnerable population. We will 
collect data from the child’s electronic health record and REDCap surveys. Many of the 
procedures required to collect these data are aspects of routine diabetes care for 
children and thus the risk for coercion/harm in participation is low. Parents will provide  
verbal permission for their child’s participation.  
 
8.0 
Local Number of Participants 
7.1 
Indicate the total number of participants or charts to be enrolled 
locally as well as the accrual goal. If the study includes multiple groups or 
cohorts, be sure to describe the number of participants required for each 

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cohort. If one of the groups includes a chart review, each chart is 
considered a participant and needs to be reflected in the numbers below.  
7.2 
 
 
Prescreening 
TID: 17-19 years 
old 
 
 
Enrollment Goal: 
Number of participants to be enrolled = 
the number of participants to be 
consented or to be screened for chart 
reviews. 
65 
20 
 
 
9.0 
Identification and Recruitment of Potential Participants* 
8.1 
Identification of Potential Participants:   
How will participants be identified? (Check all that apply) 
 
☒ Chart reviews  
 
☒ By their treating physician who will then provide the study team’s contact 
information to the potential participant/family 
☒ By their treating physician who will obtain patient/family permission to share 
contact information with the study team 
☒ Self-refer in response to IRB approved advertisements or websites  
☒ Through Cerner or other CM sources (e.g. databases, billing records, 
pathology reports, admission logs, etc.) May involve access of records by 
individuals not involved in the patient’s care. 
☒ List of candidates provided through the Data Report Request Form  
☒ Registry of individuals interested in research opportunities   
☒ Past participant list 
☐ Participants will roll-over from another research study: Study # 
☐ Other:  
 
8.2 
Pre-Screening prior to HIPAA Authorization 

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Will any of the identification methods checked above involve 
access to Protected Health Information (PHI) prior to obtaining 
HIPAA Authorization? 
☒ Yes 
 
☐ No 
• If yes, a “Partial Waiver of HIPAA Authorization” is required.  Be sure to 
make this selection in the “HIPAA & Confidentiality” section below and 
complete Addendum E: Waiver/Alteration of HIPAA Authorization 
 
8.3 
Recruitment of Potential Participants:   
Patients will be prescreened to see if they meet enrollment criteria by a member 
of the research team. Patients who appear to meet criteria may be contacted by 
telephone or approached during a standard of care visit by a study team 
member and informed about this study. They may also learn of the study 
through the intake form, Find A Study page, or the study flyer. The flyer can be 
posted on the Diabetes Clinic intake form that families complete before 
appointments or in clinic spaces. The flyer and Study Information Sheet can be 
posted on the hospital’s Find a Study page. Patients and their parent/legal 
guardian will be given information about the study and they will determine if 
they wish to participate.  Once the potential participant has talked to a study 
coordinator about the study, the inclusion/exclusion survey will be shared with 
the participant via REDCap for completion.  
 
If Recruitment takes place via telephone CM research policy will be followed.  
Prescreening may involve either a review of clinic schedules or a report 
generated by IT that will involve a review of the electronic medical record (EMR) 
system to generate a list of potentially eligible participants.  
 
Data will be stored in both REDCap and the CM Azure Cloud. All electronic survey data 
will be stored on a CMH shared drive folder and REDCap with access given only 
to the research personnel listed on this study.  
 
31.0 Provisions to Monitor the Data to Ensure the Safety of Participants 

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See Data Management above. This study presents to more than minimal 
risk for participants.   
 
STUDY MANAGEMENT 
32.0 Setting & Locations*  N/A 
 
33.0 Multi-Site Research N/A 
 
 
34.0 International Research N/A 

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Addendum A: Waiver of Documentation of Permission/Consent 
 
Regulatory Criteria: To qualify for a waiver of documentation of parental permission or 
adult consent, the study must fit into at least one of the three scenarios below. Indicate 
which scenario(s) applies. 
 
☐ The only record linking the participant and the research would be the 
permission/consent form and the principal risk is potential harm resulting from a 
breach of confidentiality. Each parent/LAR or adult participant will be asked whether 
they want documentation linking the participant with the research, and the 
parent/LAR’s or adult participant’s wishes will govern. 
 
OR 
 
☒ The research presents no more than minimal risk of harm to participants and 
involves no procedures for which written parental permission or adult consent is 
normally required outside of the research context. 
 
OR 
 
☐ The parent(s)/LAR or adult participants are members of a distinct cultural group or 
community in which signing forms is not the norm, the research presents no more 
than minimal risk of harm to participants and an appropriate alternative mechanism 
for documenting that informed parental/LAR permission or adult consent was 
obtained will be provided. Describe the alternative mechanism provided: 

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Addendum B: Waiver/Alteration of Permission/Assent/Consent 
 
What’s the difference between a “waiver” and an “alteration” of parental permission, 
child assent, or adult consent?   
 
• A “waiver” of parental permission, child assent, or adult consent is when all 9 
required elements of permission/consent are waived. If the IRB approves a 
waiver then the study team does not need to obtain the parental permission or 
adult consent in order to include a participant in the study. 
 
• An “alteration” of parental permission, child assent, or adult consent is when 
one or more of the 9 required elements are waived because they are not 
relevant to the research activity. If the IRB approves an alteration, then the study 
team must still obtain parental permission or adult consent in order to include a 
participant in the study, but certain elements may not be required in the 
form/discussion. 
 
 
 
NOTE: If requesting a waiver of parental/LAR permission because parental permission is 
not a reasonable requirement to protect the participants [e.g. research on neglected or 
abused children], contact irb@cmh.edu to discuss additional regulatory requirements. 
 
Regulatory Criteria: To qualify for a waiver or alteration of parental permission or adult 
consent, ALL of the following must apply.  Explain how the study meets each of the 
regulatory criteria below.   
 
Criteria 
Explain how the study meets the criteria 
The research involves no more 
than minimal risk to the 
participants 
 
The research could not 
practicably be carried out 
without the requested 
waiver/alteration (i.e., explain 
why the study could not be 
done if 
permission/assent/consent 
were required) 
 
If the research involves using 
identifiable private 
information or identifiable 
 

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biospecimens, the research 
could not practicably be 
carried out without using such 
information or biospecimens 
in an identifiable format 
The waiver/alteration will not 
adversely affect the rights and 
welfare of the participants 
 
Whenever appropriate, the 
participants or legally 
authorized representatives 
will be provided with 
additional pertinent 
information after participation 
 
 
Proposed Alteration (if applicable):  
Select which required elements of permission are to be omitted. 
☐ A statement that the study involves research, an explanation of the purposes of 
the research and the expected duration of the participant's participation, a 
description of the procedures to be followed, and identification of any 
procedures that are experimental; 
 
☐ A description of any reasonably foreseeable risks or discomforts to the 
participant; 
 
☐ A description of any benefits to the participant or to others that may reasonably 
be expected from the research; 
 
☐ A disclosure of appropriate alternative procedures or courses of treatment, if any, 
that might be advantageous to the participant; 
 
☐ A statement describing the extent, if any, to which confidentiality of records 
identifying the participant will be maintained; 
 
☐  For research involving more than minimal risk, an explanation as to whether any 
compensation and an explanation as to whether any medical treatments are 
available if injury occurs and, if so, what they consist of, or where further 
information may be obtained; 
 
☐  An explanation of whom to contact for answers to pertinent questions about the 
research and research participants' rights, and whom to contact in the event of a 
research-related injury to the participant; 
 

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☐  A statement that participation is voluntary, refusal to participate will involve no 
penalty or loss of benefits to which the participant is otherwise entitled, and the 
participant may discontinue participation at any time without penalty or loss of 
benefits to which the participant is otherwise entitled; and 
 
☐  One of the following statements about any research that involves the collection 
of identifiable private information or identifiable biospecimens: 
 
☐  A statement that identifiers might be removed from the identifiable private 
information or identifiable biospecimens and that, after such removal, the 
information or biospecimens could be used for future research studies or 
distributed to another investigator for future research studies without 
additional informed consent from the participant or the legally authorized 
representative, if this might be a possibility; or 
 
☐  A statement that the participant's information or biospecimens collected as 
part of the research, even if identifiers are removed, will not be used or 
distributed for future research studies. 
 
Provide the rationale for omitting the item(s) selected: 
 
 
 

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Addendum C: Non-English Speaking Participants 
 
There are special considerations that must be made when obtaining 
permission/assent/consent from participants who prefer to communicate in a language 
other than English. To ensure that adequate processes are in place to obtain effective 
permission/assent/consent from these participants address each of the items below. 
 
Indicate which language(s) other than English are understood by prospective 
participants or representatives. 
 
☐  Spanish 
☐  Arabic 
☐  Burmese 
☐  Somali 
☐  Vietnamese 
☐  Other:_______________________________________________ 
 
 
Describe the plan for enrolling non-English speaking participants (e.g. fully translated 
consent forms, use of Qualified Bilingual Study Staff or interpreters): 
 
 
 
If providing fully translated consent forms, explain if the ORI Translation Program for 
internally and/or federally funded studies will be used, or if translation services will be 
obtained through the study sponsor or some other service. 
NOTE: If using ORI Translation Program services for an industry sponsored study, contact 
Research Business Operations staff to get this negotiated in the study 
agreement/contract. 
 
 

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Addendum D: Surrogate Decision Maker Consent 
 
Assessment of Decision-Making Capacity:   
• Describe the process to determine whether an individual is capable of consent. 
See CM Research Policy 9.10 Incapacity, Temporary or Fluctuating Decision-
Making Capacity for more information on the proper procedures for enrolling 
adults who are not able to consent for themselves. 
 
Identification of Surrogate Decision Maker 
• List the individuals from whom permission will be obtained in order of priority, 
e.g. durable power of attorney for health care, court appointed guardian for 
health care decisions, spouse, and adult child. 
• For research conducted in the states of Missouri and/or Kansas, review  CM 
Research Policy 9.10 Incapacity, Temporary or Fluctuating Decision-Making 
Capacity to be aware of which individuals in the state meet the definition of 
“legally authorized representative.” 
• For research conducted outside of Missouri and/or Kansas, provide information 
that describes which individuals are authorized under applicable law to consent 
on behalf of a prospective participant to their participation in the procedure(s) 
involved in this research. One method of obtaining this information is to have a 
legal counsel review the protocol. 
 
Assent of Adult Participant 
• Describe the process for assent of the adult participants who are unable to 
consent for themselves. Indicate whether: 
o Assent will be required of all, some, or none of the participants. If some, 
indicate which participants will be required to assent and which will not. 
o If assent will not be obtained from some or all participants, an 
explanation of why not. 
o Describe whether assent of the participants will be documented and the 
process to document assent. The IRB allows the person obtaining assent 
to document assent on the consent document and does not routinely 
require assent documents or require participants to sign assent 
documents. 
o Describe how participants will be closely monitored.  
o Describe whether participants will be withdrawn if they appear to be 
unduly distressed. 
 
 

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Addendum E: Waiver/Alteration of HIPAA Authorization 
 
 
What’s the difference between a “waiver” and an “alteration” of HIPAA 
Authorization? 
 
• A “waiver” of HIPAA Authorization is when the requirement to obtain 
authorization is completely waived. If the IRB approves a waiver then the study 
team does not need to obtain HIPAA Authorization in order to include a 
participant in the study. 
 
• An “alteration” of HIPAA Authorization is when one or more of the required 
elements of authorization are waived.  If the IRB approves an alteration then 
the study team must still obtain HIPAA Authorization in order to include a 
participant in the study, but certain elements may not be required in the 
form/discussion.  The study team should still verify the identity of the participant 
as part of the process.  For an online survey, for example, this could be 
accomplished by having the participant type in their name. 
 
 
 
Regulatory Criteria: To qualify for a waiver/alteration of HIPAA Authorization, ALL of the 
following must apply to a study. Explain how the study meets each of the regulatory 
criteria below.   
 
Criteria 
Explain how the study meets the 
criteria 
The use or disclosure of PHI involves no 
more than minimal risk to the privacy of 
individuals based upon the following:  
a. Plan to protect PHI from 
improper use and disclosure: 
b. Plan to destroy PHI at the 
earliest opportunity, unless 
there is a health or research 
justification for retaining the 
PHI: 
c. Assurance that PHI will not be 
reused or disclosed to any 
other person or entity: 
 
The study team will maintain a 
password protected recruitment 
log during the active portion of 
the study. Only members of the 
study team will have access. This 
will allow the study team to avoid 
approaching potentially eligible 
families more than once.  
 
PHI will be destroyed after 
publication.  
 
PHI will not be reused or disclosed 
to any other person or identity.  

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Citations 
 
 
Oser TK, Oser SM, Parascando JA, Hessler-Jones D, Sciamanna CN, Sparling K, 
Nease D Jr, Litchman ML. Social Media in the Diabetes Community: a Novel Way 
to Assess Psychosocial Needs in People with Diabetes and Their Caregivers. Curr 
Diab Rep. 2020 Feb 20;20(3):10. doi: 10.1007/s11892-020-1294-3. PMID: 
32080765. 
 
The research cannot practicably 
be conducted without the 
waiver/alteration, i.e. explain why 
a signature for HIPAA 
Authorization cannot be obtained. 
Partial HIPAA Waiver for 
Screening: 
It would not be practical to obtain 
HIPAA authorization for every 
person screened as they will not 
know who meets the inclusion 
criteria until the records are 
accessed 
 
Alteration for HIPAA 
Authorization: 
 The consent process will take 
place remotely. The study team 
will not have face to face 
interaction with participants for 
the study. 
The research cannot practicably 
be conducted without access to 
and use of the PHI, i.e. explain 
why access to PHI is needed for 
this study. 
Partial HIPAA Waiver for 
Screening: 
PHI must be accessed in order to 
determine eligible patients for 
recruitment. 
Alteration for HIPAA 
Authorization: 
All collected data is needed to 
meet the study aims.  

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Wu N, Wang SJ, Brazeau AS, Chan D, Mussa J, Nakhla M, Elkeraby M, Ell M, 
Prevost M, Lepine L, Panagiotopoulos C, Mukerji G, Butalia S, Henderson M, Da 
Costa D, Rahme E, Dasgupta K. Supporting and Incentivizing Peer Leaders for an 
Internet-Based Private Peer Community for Youths With Type 1 Diabetes: Social 
Network and Directed Content Analysis. J Med Internet Res. 2023 Dec 
12;25:e48267. doi: 10.2196/48267. PMID: 38085568; PMCID: PMC10751631.