Promoting glycemic control in young children with type I diabetes: Results from a pilot intervention for parents.

Abstract

Objective: Nutrition and physical activity are key components of daily diabetes care in young children with type I diabetes (T1D). Normative developmental behavioral challenges related to nutrition and physical activity complicate management of T1D. The current pilot study evaluated the feasibility, acceptability, and indications of behavior change of an intervention aimed at improving nutrition and physical activity in young children with T1D. Method: Thirty-6 parents of young children (ages 2-5 years, M = 4.2) with T1D from 2 clinics in the Washington, DC area were randomized to receive the type One Training (TOTs) program or Usual Care (UC). Assessments included recruitment and completion rates, participant acceptability, and outcomes including glycemic variability via continuous glucose monitoring, nutritional intake via remote food photography, physical activity via accelerometers, and parental report on behavior and psychosocial functioning. Results: Despite recruitment challenges, the TOTs program was feasible to administer, with high program and assessment completion rates. Acceptability ratings were very high but differed by recruitment site. Participants randomized to TOTs had an increase in percent of time in target glycemic range and reduction in behavioral feeding problems between baseline and follow-up while those randomized to UC did not. Participants in UC demonstrated a decrease in in moderate to vigorous physical activity at follow-up. Conclusions: The TOTs program demonstrated preliminary feasibility and acceptability. Future research will examine components of treatment for evidence of efficacy and target the intervention to those most likely to benefit.

Effects of Low-Calorie Sweetener Restriction on Glycemic Variability and Cardiometabolic Health in Children with Type 1 Diabetes: Findings of a Pilot and Feasibility Study

“…Participant recruitment was particularly challenging, with twelve patients approached for every one participant ultimately enrolled in the study. Response, recruitment, and retention rates were all lower than anticipated, considering that rates of trial participation among children with T1D seen at Children's National are typically higher than in the present study [30,31].…”

Integrating psychosocial and behavioral interventions into type 1 diabetes care

“…Lastly, a pilot RCT ( n = 36) tested the Type 1 Training (TOTs) program which aimed to improve nutrition and physical activity in 2–5 years olds with T1D [15 ▪ ]. TOTs consisted of 6 psychoeducation sessions (5 individual, 1 group) with a master's level clinical social worker, one session with a CDCES and the social worker, and parent peer coaching.…”

“…With respect to glycemia, nine studies reported favorable changes [12 ▪ ,13 ▪▪ ,14 ▪ ,15 ▪ ,22 ▪ ,23,26 ▪ ,28 ▪▪ ,30 ▪▪ ], seven found no change [9,10 ▪▪ ,16 ▪ ,18,19 ▪ ,21,31 ▪ ], and one reported an increase in HbA1c among intervention recipients [20 ▪ ]; five studies did not evaluate or report glucose metrics [8 ▪ ,24,25 ▪▪ ,27 ▪ ,29 ▪ ]. Psychosocial care is important independent of its relationship to glucose, and should be provided irrespective of the likelihood of improving glycemia.…”

“…A promising theme within these studies is the effective use of stepped care intervention approaches [20 ▪ ,28 ▪▪ ,32], which may more efficiently utilize scarce resources for psychosocial care within clinical settings. Group interventions [9,15 ▪ ,16 ▪ ,17,21,22 ▪ ,28 ▪▪ ,29 ▪ ], and automated intervention components [19 ▪ ,23,26 ▪ ,31 ▪ ], are additional strategies to increase access to psychosocial care in resource-poor settings. However, few studies reported pragmatic findings such as cost analyses, which could help to accelerate implementation of promising intervention approaches.…”