Adapting Single Sessions Interventions for Type 1 Diabetes (ASSISTED): Integrated Pediatric Care to Reduce Depression and HbA1c

PROJECT SUMMARY/ABSTRACT Type 1 diabetes (T1D) is a common pediatric chronic medical condition that involves a complex daily regimen. Most children and adolescents with T1D do not meet glycemic control recommendations, suggesting that many likely struggle to manage T1D effectively. Behavioral interventions exist to help youth with T1D engage with their treatment regimen and achieve lower glycemic levels. However, in diabetes clinics, it is challenging to implement these interventions because they are costly to deliver, often involve multiple sessions spanning weeks or months, and require access to mental health providers. The recently emphasized practice of depression screening in pediatric diabetes clinics has increased the number of mental health referrals, as 20-30% of youth with T1D endorse elevated depressive symptoms. Yet, most pediatric diabetes clinics are understaffed with mental health providers, and only <25% of youth referred for outpatient treatment follow through with an appointment. Targeted single-session interventions (SSIs) may alleviate barriers to accessing traditional outpatient therapy and reduce depressive symptoms in youth with T1D, but an SSI that incorporates evidence-based strategies to treat depressive symptoms and lower HbA1C for youth with T1D does not yet exist. The proposed K23 career development award aims to address these gaps in research and clinical care by adapting and pilot testing a T1D-specific depression SSI integrated into pediatric T1D medical care. The first goal is to create a T1D-specific depression SSI treatment manual by eliciting feedback from a small group of adolescents. The second goal is to examine the feasibility, acceptability, and initial efficacy of an integrated T1D-specific depression SSI approach in a randomized pilot trial to reduce depressive symptoms and lower glycemic levels in youth with T1D. The third goal is to understand the barriers and facilitators of implementing the SSI approach in diabetes clinics for further refinement in follow-up testing. Piloting an integrated SSI approach could lead to improvements in the acute and long-term psychological and physical health of youth with T1D and increase the accessibility, scalability, and cost-effectiveness of psychological treatment within pediatric T1D care. Moreover, this research plan supports the candidates’ career development goals of gaining advanced training in clinical trial research design and methods, becoming an expert in feasible and flexible intervention designs (e.g., SSIs), enhancing knowledge of integrated healthcare in pediatric diabetes, and developing interventions that minimize barriers to care. Through a combination of formal didactics and direct mentored training experiences with her mentoring team, Dr. Monzon will gain the necessary knowledge and skills to implement the proposed research project and transition toward an independent research career. Further, the findings from the proposed project will inform an R01 application to conduct a larger, multisite randomized trial that has sufficient power to examine the efficacy of the T1D-specific depression SSI.