Background: YAs with T1D have more complications and mental health challenges, and are less engaged in care, than other age groups. Few studies have examined factors predicting engagement in self-management interventions, which may support YAs’ T1D care and overall well-being. Methods: Using data from a T1D self-management RCT, we analyzed predictors of engagement among those randomized to the intervention who had reached the 6 month endpoint. Engagement was defined as the number of completed intervention sessions. Control variables were measured at baseline. Ordinary least-squares regression was used, entering categories of predictors in separate steps: 1) demographics: age, gender, race/ethnicity, insurance status, parental education; 2) clinical: A1c, duration of T1D, device use; 3) behavioral: medication adherence, diabetes self-management (DSMQ); 4) psychosocial: diabetes distress (DDS), self-efficacy (DES-SF), and autonomous motivation (TSRQ). Results: Participants (n=87) were 24 (±4) yrs old, 60% female, 49% Hispanic/Latinx and 43% White, and completed a mean of 9.5 intervention sessions (range: 0-24). In the final model (p=0.0003), engagement was associated with low parental education (parameter estimate -4.1 visits), being uninsured (+3.6 visits), and higher glucose monitoring (-1.1 visits) and physical activity (-0.6 visits) on the DSMQ. Discussion: Clinical and psychosocial variables were unrelated to OT visits; to an extent, poorer self-management predicted more visits. Indicators of SES were most predictive: low parental education decreased, and uninsured status increased, number of OT visits. Given that the factors most associated with engagement were indicators of SES, clinicians are encouraged to assess barriers and external factors that may impact access and participation as soon as possible in the therapeutic process, to facilitate engagement in services. Disclosure E.Pyatak: Research Support; Abbott Diabetes. J.Sideris: None. D.Fox: None. G.Granados: None. J.Diaz: None. J.Blanchard: None. A.R.Khurana: None. E.Salcedo-rodriguez: None. J.Raymond: None.
Background: The prevalence of type 1 diabetes (T1D) is increasing within racially and ethnically marginalized populations, highlighting the need for effective recruitment strategies that not only address healthcare disparities but also rebuild trust in medical research. Recently, the CoYoT1 to California (CTC) study evaluated a person-centered care model designed to support racially and ethnically diverse young adults (YA) who receive care at a hospital-based pediatric T1D clinic. In addition to treatment effectiveness, the study examined the success of recruitment strategies. Methods: Potential YA participants were approached in-person or remotely (by phone, email, or text). Those with clinic appointments during study recruitment were approached in-person, with recruiters focusing on cultural humility to connect with families; the concept and process of research was introduced, and families were allowed to ask questions as needed. Remote recruitment utilized multiple pre- and post-appointment messages with basic descriptions of the study or follow-up details as needed. Categorical data were compared using chi-squared tests. Results: The study approached 338 potential participants and recruited 68 (20%). Reflecting successful recruitment of diverse YA, study participants were representative of the clinic population in terms of racial and gender identities, and identified as Latinx (29, 43%) more often than those who declined (100, 37%; P=0.40). Recruitment strategy was significantly associated with participation, as most participants were recruited in-person (40, 59%), while most who declined did so remotely (200, 74%; P<0.0001). Conclusion: In-person recruitment is more effective for enrolling diverse YA and their families, as it allows recruiters to build rapport, and empowers families with information and choice. Internal and external barriers may prevent diverse YA from attending clinic appointments in-person, ultimately impacting research equity. Disclosure F.Gonzalez: None. M.W.Reid: None. E.Salcedo-rodriguez: None. J.Flores garcia: None. S.Hiyari: None. A.Torres sanchez: None. E.Pyatak: Research Support; Abbott Diabetes. D.Fox: None. J.Raymond: None. Funding Patrick and Catherine Weldon Donaghue Medical Research Foundation
Introduction: Young adults (YAs) with T1D experience poorer self-care, psychosocial well-being and clinical outcomes relative to other age groups. A better understanding of factors that drive these challenges is needed to better support this age group. Behavioral science theory suggests that greater autonomous (vs. controlled) motivation (the degree to which behaviors are motivated by internal vs. external drivers) may enable YA to more effectively navigate the challenges of living with T1D. Methods: Baseline surveys and clinical data from an ongoing self-management RCT were analyzed to examine associations between autonomous motivation (modified TSRQ) , glycemic control (HbA1c) , diabetes distress (DDS) , diabetes self-management (DSMQ) , self-efficacy (DES-SF) , and quality of life (ADD-QoL) . All analyses were adjusted for treatment regimen (injections/pump/CGM) . Results: Among 133 YA with T1D (24.2±3.7 yrs, 53% female, 53% Latinx, 36% White, 11% multiethnic/other) , more autonomous motivation was associated with lower diabetes distress (standardized b= -0.19, p=0.04) and better self-management (b=0.18, p=0.04) . Analyses revealed that the association of autonomous motivation with lower diabetes distress scores was attributable to its associations with the emotional burden (b=-0.17, p=0.05) and regimen distress (b=-0.24, p=0.01) subscales, and its association with higher self management scores was driven by its association with the glucose monitoring subscale (b=0.32, p=0.0005) . Relationships between motivation and other measures were not significant. Conclusion: Among YA with T1D, those with greater autonomous motivation for diabetes care had lower regimen distress and emotional burden, and greater glucose monitoring. While the causal direction of these relationships is unclear, it is plausible that interventions to enhance autonomous motivation may enhance self-management and well-being in this population. Disclosure E.Pyatak: Research Support; Abbott Diabetes. E.Taylor: None. J.Raymond: None. C.Vigen: n/a. J.Sideris: None. D.Fox: None. J.Diaz: None. A.Ali: None. J.Blanchard: None. G.Granados: None. E.Salazar: None. Funding National Institutes of Health (R01DK116719)
Background: VPG have been shown to improve psychosocial well-being in AYA with T1D, but it is unknown what aspects of VPG are most or least valued. Methods: CoYoT1 to California is a 15 month randomized controlled trial for patients ages 16-25 with T1D. AYA received Usual Care (n=28) or CoYoT1 Care (n=40) , which consisted of patient-centered provider visits and bimonthly VPG led by a YA with T1D. VPG were AYA-driven discussions focused on topics pertinent to AYA with T1D, emphasizing problem-solving and emotional support. At study end, VPG participants responded to a survey about their preferences for intervention features. Results: CoYoT1 Care patients were 40% female, 53% Latinx, and 72% publicly insured; and they attended 1.9 VPG each on average. AYA who attended at least one VPG participated in 4.1 VPG on average. The average session had 4.5 AYA present; each topic was covered by 9.6 AYA on average. Most survey respondents (75%) reported VPG were extremely or very valuable in supporting their T1D care. Seeing peers use diabetes technology and being supported by same-aged peers with T1D increased VPG value the most. Larger group size and not feeling comfortable sharing decreased value the most. Conclusion: Peer interactions may support unmet needs of AYA with T1D from diverse backgrounds. Further work will help optimize the design of VPG based on patient preferences. Disclosure D.I.Bisno: None. E.Pyatak: Research Support; Abbott Diabetes. M.W.Reid: None. D.Fox: None. J.L.Fogel: None. E.Salcedo-rodriguez: None. J.J.Flores garcia: None. A.Torres sanchez: None. J.Raymond: None. Funding The Donaghue Foundation
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