Psychosocial outcomes in young adolescents with type 1 diabetes participating in shared medical appointments

Abstract

For youth with type 1 diabetes (T1D), the early adolescent period is associated with worsening diabetes management and high rates of negative psychosocial issues, including depressive symptoms and family conflict. Alternative clinical models may help improve both diabetes and psychosocial outcomes. Our study aims to investigate whether Team Clinic, a shared medical appointment model developed specifically for adolescents with T1D, will improve psychosocial outcomes for middle school‐aged youth. Youth with T1D, 11–13 years of age, and their caregivers, participated in a randomized controlled trial comparing Team Clinic to traditional clinic visits (control group). Diabetes characteristics were obtained at every visit. Participants and caregivers completed depression screening and family conflict questionnaires at baseline and end of study. Changes in mean scores on clinical and psychosocial outcomes from baseline to end of study were compared between groups using linear mixed‐effects models. Eighty‐six youth (51% female; 74% White; 10% Hispanic) completed at least one visit during the 12‐month study period. At the end of the study, control group participants reported increases in Emotional Problems compared to Team Clinic participants, including higher levels of Negative Mood/Physical Symptoms (p = 0.02). Team Clinic participants reported reduced family conflict surrounding diabetes at study end, compared to control group participants (p = 0.03). Caregivers did not report change in depressive symptoms or family conflict during the study. Hemoglobin A1C levels did not change over time in either group. Participation in Team Clinic was associated with improved psychosocial outcomes in middle school‐aged participants with T1D.

Virtual Group Appointments Reduce Distress and Improve Care Management in Young Adults with Type 1 Diabetes

“…Consistent with previous research on the CoYoT1 Clinic, 20,22 many YA reported elevated depressive symptoms at baseline and maintained these levels throughout the study. Elevated CES-D scores exceeded 16, which epidemiologic data suggests is a cutoff for participants who may meet the diagnostic criteria for depression.…”

“…18,19 The benefits of group appointments have been demonstrated, [16][17][18][19] but evidence of positive effects following random assignment (as opposed to self-selection into the intervention) is scarce. One study, of the Team Clinic in-person group appointment model in adolescents, shows positive psychosocial benefits in the form of reduced familial conflict and improved mood, 20 but the effects of this type of intervention delivered virtually to YA patients are unknown.…”

5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023

“…There are opportunities for diabetes health care professionals to routinely monitor and screen psychosocial status in a timely and efficient manner for referral to appropriate services (324,325). Various health care professionals working with people with diabetes may contribute to psychosocial care in different ways based on training, experience, need, and availability (313,326,327). Ideally, qualified mental health professionals with specialized training and experience in diabetes should be integrated with or provide collaborative care as part of diabetes care teams (328)(329)(330)(331), or referrals for in-depth assessment and treatment for psychosocial concerns should be made to such mental health professionals when indicated (314,332,333).…”

“…Psychosocial interventions can be delivered via digital health platforms (356). Groupbased or shared diabetes appointments that address both medical and psychosocial issues relevant to living with diabetes are a promising model to consider (327,357).…”

Baseline Quality Improvement Capacity of 33 Endocrinology Centers Participating in the T1D Exchange Quality Improvement Collaborative

“…LHS, which include applying real-world EHR data, building QI capacity, and embedding clinical research into population health improvement (10). These efforts have been highlighted in recent publications exploring insights from EHR data (11)(12)(13), QI efforts leading to increases in diabetes technology uptake (14)(15)(16), and timely insights into adaptations to clinical care during the coronavirus disease 2019 pandemic (17)(18)(19).…”