Application of the Telemedicine for Reach, Education, Access, and Treatment delivery model to engage emerging adults in Diabetes Self-Management Education and Support (TREAT-ED)

Abstract Diabetes self-management education and support (DSMES) is considered a cornerstone of care and essential in helping people navigate self-management decisions and activities. Despite evidence that DSMES is a critical component of diabetes care, participation remains low. Emerging adulthood (EA) has been described as the distinct period between 18 and 25 years when adolescents work to achieve autonomy and explore life possibilities in moving toward adulthood. Suboptimal self-management has been identified as a major problem in EAs with type 1 diabetes (T1D), a particularly vulnerable group with an increased risk for poor diabetes-related outcomes. In its current form DSMES has been cited for not meeting the needs of EAs, when EAs have expressed interest in DSMES delivered with peer-supported, technological and applied learning-driven methods. To address these challenges, we are applying information gained from the literature and key stakeholders to our established Telemedicine for Reach, Education, Access and Treatment (TREAT) delivery model with a specific focus on DSMES. TREAT-ED (for self-management EDucation) will be designed to specifically engage EAs in DSMES by integrating DSMES objectives to support informed decision making, self-care, and preparation for transfer to adult care, to improve outcomes. Diabetes care and education specialists (DCESs) will lead TREAT- ED with a cohort of EAs and will 1) help to organize and facilitate group sessions delivered through telehealth and 2) use continuous blood glucose monitoring (CGM) reports as personalized examples to drive established DSMES content. With user-centered design techniques, we will evaluate implementation determinants and then develop, build, and test the TREAT-ED model. Feasibility assessment of the impact of the model on EA patient participation in DSMES along with clinical, psychosocial and behavioral outcomes will be examined. We hypothesize that models that rely on current day strategies to engage EAs at high risk for diabetes-related problems with effective self-management skills will improve DSMES engagement and outcomes. If proven to be effective, this model is one that could be adapted for EAs who have transferred to adult diabetes care and other patient populations throughout the US.