Reducing Stress in Adolescents and Young Adults With Type 1 Diabetes to Improve Diabetes Care
Condition: Type 1 Diabetes
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 1
Study type: Interventional

Summary: 
      Adolescence and young adulthood may be particularly stressful developmental periods due to
      the numerous transitions into new roles and the need for increased independence. Stress can
      affect metabolic control in older adolescents and young adults with T1D directly through its
      impact on cortisol and other hormones that affect insulin metabolism.

      The proposed study is a pilot randomized clinical trial using a three-group randomized,
      repeated measures design to assess the efficacy of two treatments (Mindfulness Based Stress
      Reduction (MBSR) and Cognitive Behavioral Therapy or (CBT) versus an attention control
      condition for older adolescents and young adults with poorly controlled Type 1 diabetes. As a
      pilot study, the goal of the research is to test recruitment and retention procedures,
      finalize intervention measures, training, and fidelity protocols, and estimate effect sizes
      for a larger clinical trial.
    

Detailed description: 
      This study will use a randomized, repeated measures design. A sample of 125 participants will
      be recruited and consented from the Children's Hospital of Michigan and outpatient diabetes
      clinics affiliated with the Detroit Medical Center. 108 will be randomized to one of three
      treatment conditions (remaining participants are expected to consent but not enroll or fail
      to initiate treatment). These participants will be enrolled in 3 cohorts of 30-36
      participants.

      Measures will be administered at 3 home-based study visits to maximize participant
      convenience. The initial study visit (Visit 1) will be scheduled at the beginning of the
      study. Visit 2 will coincide with the end of treatment which is approximately 3 months after
      the initial study visit. Visit 3 is the 3-month follow up and will be scheduled about 6
      months after the initial study visit. At each visit, participants will complete
      questionnaires assessing their current diabetes management, stressors, quality of life,
      mental health, and demographic characteristics. These questionnaires will be completed using
      Qualtrics accessed via the internet on a university laptop computer. A research assistant
      will download the participant's glucose meter to obtain the frequency of blood glucose
      testing during the two weeks preceding data collection. The research assistant will also
      assist participants with providing a blood sample via fingerstick (HbA1c) and saliva samples
      by mouth (cortisol, Visits 1 and 2 only). All participants will be asked to take part in an
      exit interview at Visit 3 to obtain feedback on the treatment they received.

      After Visit 1, participants will be randomized using a 1:1:1 ratio to MBSR, CBT, or Diabetes
      Support and Education (DSE). All three treatments are group format meeting (10-12
      participants per group) for nine consecutive weeks at a location convenient to the
      participants. In MBSR treatment focuses on the instruction and practice of mindfulness
      techniques, such as meditation and yoga, and the application of these practices to everyday
      activities. CBT utilizes activities to understand how thoughts affect emotions and behaviors,
      the application of these activities to current stressors, and strategies to apply these new
      skills to future stressors. The DSE group is the attention control condition; DSE
      participants will receive diabetes education via a support group format. All group sessions
      will be audiotaped for treatment fidelity monitoring and assessment. There are no planned
      research interventions for the DSE group.
    

Intervention name(s): Cognitive Behavioral Therapy; Mindfulness Based Stress Reduction; Diabetes Support and Education
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Participants will attend group therapy sessions, once a week for 9 weeks. The focus of these sessions will be the thought-emotion-behavior linkages as outlined by cognitive-behavioral theory. Activities will illustrate how thoughts affect emotions and behaviors, the application of these activities to current stressors, and strategies to apply these new skills to future stressors.; Participants will attend group therapy sessions, once a week for 9 weeks. The focus of these sessions will be understanding how to gain control over one's thoughts and feelings using relaxation, meditation, and other mindfulness-based techniques. Activities will focus on the instruction and practice of mindfulness techniques, such as meditation and yoga, and the application of these practices to everyday activities.; Participants will attend group therapy sessions, once a week for 9 weeks. Participants will receive diabetes education via a support group format. The focus of these sessions will be peer group social support and non-adherence diabetes education topics (e.g., emergency preparedness, smoking and diabetes).
Other intervention name(s): CBT; MBSR; DSE
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: insulin dependent diabetes mellitus; adolescents and young adults; stress reduction; metabolic control