Mindfulness-Based Stress Reduction in Adolescents with Type 1 Diabetes

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PROJECT SUMMARY Type 1 diabetes (T1D) is one of the most prevalent chronic conditions in adolescents in the United States, affecting approximately 1 in 400 adolescents by 18 years of age. Adolescents with T1D are at risk for acute and long-term complications, including diabetic ketoacidosis, severe hypoglycemia, and cardiovascular, renal, and neuropathic disease. Maintaining adequate glycemic control reduces the risk of these complications. Anxiety symptoms are prevalent in adolescents with T1D, occurring at approximately 2 to 3 times the rate of the general adolescent population. Anxiety symptoms are associated with out-of-range glycemic control, poor quality of life (QOL), and poor self-management. Targeted interventions to reduce anxiety symptoms will contribute to improved QOL and improved self-management of T1D and thus improved disease outcomes. Despite the high prevalence of anxiety symptoms and strong associations with diabetes-related complications, few evidence-based interventions have been adapted for this high-risk population. This proposal uses a systematic and iterative approach to adapt an evidence-based intervention for anxiety symptoms, mindfulness- based stress reduction (MBSR), specifically to meet the developmental and lifestyle needs of this population. My goal in seeking a Mentored Research Career Development Award is to acquire the knowledge, skills, and research experience necessary to become an independent clinical investigator focused on developing, implementing, and testing behavioral interventions and improving disease outcomes in adolescents with Type 1 diabetes (T1D). This proposal constructs and tests the feasibility and acceptability of an adapted MBSR mHealth application for adolescents with T1D. The specific aims of this mixed methods proposal are to: 1. Analyze qualitative interviews with 20 adolescents with T1D and conduct interviews with 10 key stakeholders (pediatric endocrinologist, pediatric endocrinology (PE) nurse practitioner, PE nurse, PE psychologist, and PE social worker) to ascertain challenges, needs, and perceptions related to anxiety management, mindfulness- based interventions, and mHealth application features.; 2. Generate an mHealth application prototype that integrates data obtained from Aim 1 to adapt MBSR specifically for adolescents with T1D; 3a. Evaluate the MBSR mHealth application prototype for engagement, feasibility, and acceptability among 40 adolescents with T1D; and 3b. Explore preliminary efficacy of the adapted MBSR mHealth application prototype on anxiety symptoms, QOL, self-management, and glycemic control in 40 adolescents with T1D. Proposed career and learning objectives are to: 1. Develop comprehensive knowledge of mHealth intervention development and implementation.; 2. Acquire intensive training in the delivery of MBSR.; and 3. Disseminate findings through national and international presentations, and peer-reviewed publications. Long-term career goal: Build a robust program of externally-funded research to develop and disseminate interventions that are sustainable and actively utilized in clinical practice.