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.
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)
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