The moderating role of diabetes distress on the effect of a randomized eHealth intervention on glycemic control in Black adolescents with type 1 diabetes

J Pediatr Psychol. 2024 Aug 1;49(8):538-546. doi: 10.1093/jpepsy/jsae033.

Abstract

Objective: Due to systemic inequities, Black adolescents with type 1 diabetes are more likely to have suboptimal glycemic control and high rates of diabetes distress, but tailored interventions for this population are lacking. In primary outcomes of a randomized clinical trial, a family-based eHealth intervention improved glycemic control in Black adolescents with type 1 diabetes and elevated depressive symptoms. The present study is a secondary analysis of these clinical trial data examining the moderating effect of diabetes distress on the efficacy of the intervention.

Methods: Using secondary data from a multicenter randomized clinical trial (Clinicaltrials.gov [NCT03168867]), caregiver-adolescent dyads were randomly assigned to either up to three sessions of an eHealth parenting intervention (n = 75) or a standard medical care control group (n = 74). Black adolescents (10 years, 0 months to 14 years, 11 months old) with type 1 diabetes and a caregiver willing to participate were eligible. Adolescents reported their diabetes distress at baseline, and hemoglobin A1c (HbA1c) data were collected at baseline, 6-, 13-, and 18-month follow-up.

Results: No between-group contrasts emerged in a linear mixed-effects regression (p's > .09). Within-group contrasts emerged such that adolescents assigned to the intervention who reported high diabetes distress had lower HbA1c at the 18-month follow-up relative to baseline (p = .004); the 18-month decrease in HbA1c was -1.03%.

Conclusions: Black adolescents with type 1 diabetes and high levels of diabetes distress showed significant decreases in HbA1c following a family-based eHealth intervention, suggesting diabetes distress may be a key moderator of intervention efficacy within this population.

Keywords: adolescent diabetes; diabetes distress; disparities research; parenting; technology in health care.

Publication types

  • Randomized Controlled Trial
  • Multicenter Study

MeSH terms

  • Adolescent
  • Black or African American* / psychology
  • Caregivers / psychology
  • Child
  • Depression / psychology
  • Depression / therapy
  • Diabetes Mellitus, Type 1* / blood
  • Diabetes Mellitus, Type 1* / psychology
  • Diabetes Mellitus, Type 1* / therapy
  • Female
  • Glycated Hemoglobin* / analysis
  • Glycemic Control* / psychology
  • Humans
  • Male
  • Parenting / psychology
  • Psychological Distress*
  • Stress, Psychological / therapy
  • Telemedicine*

Substances

  • Glycated Hemoglobin

Associated data

  • ClinicalTrials.gov/NCT03168867