The purpose of this study was to develop an Internet coping skills training program and to evaluate its feasibility and acceptability compared with an Internet education intervention for teenagers with type 1 diabetes. A multiphase mixed-methods design with focus groups, a randomized pilot study, and a program evaluation was used. Teenagers with type 1 diabetes, parents, and health professionals were included in the development and evaluative phases along with the research and information technology team. The pilot study included 12 teenagers with type 1 diabetes (mean [SD] age, 14.4 [.90] years; 58% female; mean [SD] duration of diabetes, 5.9 [3.0] years). Psychosocial data and HbA 1c levels were collected at baseline and at 3 and 6 months. Results indicate that the development of a psychosocial Internet intervention was complex and required multiple iterations of development and evaluation. Results of this study also indicate the feasibility and acceptability of translating a group-based intervention for teenagers with type 1 diabetes to the Internet. Thus, this study demonstrates a systematic approach to Internet intervention development. Including teenagers with type 1 diabetes and a multidisciplinary professional team into the intervention design was critical to the success of this project. KeywordsAdolescents with type 1 diabetes; Coping skills training program; InternetThe Diabetes Control and Complications Trial demonstrated that in adolescents older than 13 years, intensive management and improved metabolic control reduced complications by 27% to 76%. 1 However, intensive management of type 1 diabetes (T1D) is complex and requires frequent monitoring of blood glucose, frequent insulin injections or use of continuous subcutaneous insulin infusion, and regular visits to healthcare providers. Significant effort on the part of the adolescent and the family is necessary to achieve treatment goals.Normal childhood development can present challenges to T1D management. In adolescence, metabolic control tends to deteriorate as a combined result of insulin resistance that accompanies the hormonal changes of adolescence and lower adherence to the treatment regimen often associated with the desire for autonomy. 2 The shift from parental support to peer support is normal during adolescence; however, it can place an adolescent with T1D at increased risk for poorer health outcomes. Fear of nonacceptance with peers may make an adolescent with T1D reluctant to disclose his/her diagnosis or deliberately miss blood glucose monitoring, insulin injections, or boluses, which can cause a decline in metabolic control. 3 Corresponding author: Robin Whittemore, PhD, APRN, Yale School of Nursing, 100 Church St S, New Haven, CT 06536-0740 (robin.whittemore@yale.edu). NIH Public Access Author ManuscriptComput Inform Nurs. Author manuscript; available in PMC 2010 July 15. Published in final edited form as:Comput Inform Nurs. 2010 ; 28(2): 103-111. doi:10.1097/NCN.0b013e3181cd8199. NIH-PA Author ManuscriptNIH-PA Author Manus...

Purpose The first hybrid closed loop (HCL) system, which automates insulin delivery but requires user inputs, was approved for treatment of type 1 diabetes (T1D) by the US Food and Drug Administration in September 2016. The purpose of this study was to explore the benefits, expectations, and attitudes of individuals with T1D following a clinical trial of an HCL system. Methods Thirty-two individuals with T1D (17 adults, 15 adolescents) participated in focus groups after 4 to 5 days of system use. Content analysis generated themes regarding perceived benefits, hassles, and limitations. Results Some participants felt misled by terms such as "closed loop" and "artificial pancreas," which seemed to imply a more "hands-off" experience. Perceived benefits were improved glycemic control, anticipated reduction of long-term complications, better quality of life, and reduced mental burden of diabetes. Hassles and limitations included unexpected tasks for the user, difficulties wearing the system, concerns about controlling highs, and being reminded of diabetes. Conclusion Users are willing to accept some hassles and limitations if they also perceive health and quality-of-life benefits beyond current self-management. It is important for clinicians to provide a balanced view of positives and negatives to help manage expectations.