Characterization of youth goal setting in the self‐management of type 1 diabetes and associations with HbA1c: The Flexible Lifestyle Empowering Change trial

Abstract

Introduction: Youth with type 1 diabetes (T1D) commonly do not meet HbA1c targets. Youth-directed goal setting as a strategy to improve HbA1c has not been well characterized and associations between specific goal focus areas and glycemic control remain unexplored. Objective: To inform future trials, this analysis characterized intended focus areas of youth self-directed goals and examined associations with change in HbA1c over a 18 months. Methods: We inductively coded counseling session data from youth in the Flexible Lifestyle Empowering Change Intervention (n = 122, 13-16 years, T1D duration >1 year, HbA1c 8-13%) to categorize intended goal focus areas and examine associations between frequency of goal focus areas selected by youth and change in HbA1c between first and last study visit. Results: We identified 13 focus areas that categorized youth goal intentions. Each session where youth goal setting concurrently incorporated blood glucose monitoring (BGM), continuous glucose monitoring (CGM), and insulin dosing was associated with a 0.4% (95% CI: −0.77, −0.01; P = .03) lower HbA1c at the end of intervention participation. No association was observed between HbA1c and frequency of sessions where goal intentions focused on BG only (without addressing insulin or CGM) (β:

Real‐world performance of hybrid closed loop in youth, young adults, adults and older adults with type 1 diabetes: Identifying a clinical target for hybrid closed‐loop use

“…Eighty percent CGM use equates to 5.5 days of CGM use each week, or approximately 24 days of CGM use each month. Intervention research has shown that setting goals for CGM use may help to increase success 26 . Many youth become frustrated with CGMs after a while and perceive that CGMs interfere with their lives, 27 therefore, setting goals that build in scheduled breaks in CGM use (e.g.…”

“…Many youth become frustrated with CGMs after a while and perceive that CGMs interfere with their lives, 27 therefore, setting goals that build in scheduled breaks in CGM use (e.g. wearing a CGM for 6 days, with a 1‐day break in CGM use each week) may help to prevent CGM burnout and increase the likelihood of sustaining 80% CGM use across time 26,27 ; however, research is needed to confirm if scheduled breaks in use are an effective strategy to increase CGM use.…”

Novel predictors of daily fluctuations in glycemia and self‐management in adolescents and young adults with type 1 diabetes

“…This is the first study to prospectively identify factors that predict individual daily variations in AYA's success in reaching their diabetes goals. Goal setting is a well‐known behavioural strategy to improve DSM 12,25 . Two of the 7 items of the Engagement Prediction Survey predicting daily DSM aligned with the concept of motivation, which was also identified as the strongest predictor of daily self‐management behaviour in prior research with a different population 10 .…”

Psychosocial considerations in pediatric autoimmune liver disease

“…Additional strategies include encouraging families to focus on aspects of disease management that are within their control by developing specific and attainable behavioral goals (e.g., daily medication reminders and attending follow‐up appointments). By emphasizing behavioral successes, providers can support patients and families in feeling accomplished with their participation in disease management, thereby reducing distress and impairment 9 …”