The incidence of type 1 diabetes (T1D) in young children (age <6 years) is rising. Disease management guidelines offered by the ADA and other diabetes care organizations place a high burden of responsibility onto these children's parents and caregivers to check blood sugar, administer insulin, and monitor diet and physical activity to maintain tight glycemic control. Unfortunately, this occurs at a vulnerable time in life when children's behavior is unpredictable, their T1D is difficult to control, parenting stress is elevatd, and caregivers are strained by normal child caretaking routines. T1D education and support tends to be highly concentrated at diagnosis/during the inpatient stay, and requires rapid knowledge and skill acquisition on the part of parents. Not all families respond equally well to this teaching model, and many need more guided practice, problem-solving assistance, and behavioral supports than can be offered in a one-size-fits-all patient education approach. Our research will attempt to better meet the needs of individual families through a clinical behavioral stepped care intervention for T1D in parents of young children by using real-time glycemic control and [parental depression indices] to intensify management support when indicated. Primary caregivers of young children (<6 years) newly diagnosed with T1D will be randomized to either a 3- step stepped care (treatment) or usual care (comparison) condition. Stepped care components include: T1D management support delivered by trained lay parent consultants (Step 1), T1D parenting strategies and mealtime behavior management delivered by bachelor's level behavioral assistants (Step 2), and individualized diabetes education/management planning with a certified diabetes nurse educator and [consultation with a diabetes team clinical psychologist] (Step 3). Biomedical and psychosocial measurements (including A1c, depressive symptoms, mealtime behavior, parenting stress, quality of life) will occur at baseline and 3-month intervals for up to 15 months post-diagnosis. The results of this work will ultimately lead to a more practical approach to T1D education and management that can be translated more easily into a variety of clinical practice settings to support young children's T1D management.
Type 1 diabetes is a serious public health concern, affecting 1:400 youth with an increasing incidence in young children (under 6 years of age). Type 1 diabetes directly impacts long-term health, and early adoption of successful management behaviors by parents may lead to better long-term glycemic control in children. Interventions to promote behavioral adherence to the type 1 diabetes regimen in young children are lacking, and interventions that can be translated into clinical care are needed. Consistent with provisions in the Patient Protection and Affordable Care Act's agenda of preventing chronic disease and improving public health, this research will inform clinical practice and may ultimately help improve the medical and psychosocial care of young children with type 1 diabetes.
| Rose, Meredith; Aronow, Laura; Breen, Sarah et al. (2018) Considering Culture: A Review of Pediatric Behavioral Intervention Research in Type 1 Diabetes. Curr Diab Rep 18:16 |
| Hilliard, Marisa E; Tully, Carrie; Monaghan, Maureen et al. (2017) Design and development of a stepped-care behavioral intervention to support parents of young children newly diagnosed with type 1 diabetes. Contemp Clin Trials 62:1-10 |
| Tully, Carrie; Shneider, Caitlin; Monaghan, Maureen et al. (2017) Peer Coaching Interventions for Parents of Children with Type 1 Diabetes. Curr Diab Rep 17:39 |
