Situational Problem Solving in Adolescents with Type 2 Diabetes: Enhancing an RCT

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DESCRIPTION (provided by applicant): Type 2 diabetes (T2DM) is a growing problem among adolescents, particularly in minority populations. Our initial research from the K23 award has examined barriers to the optimal management of adolescents with T2DM. Our current work has demonstrated that adolescents with T2DM often come from families with cultural, psychosocial, and socioeconomic barriers to self-management. Many of these adolescents have multiple family members with diabetes or obesity that can act as positive, but also negative role models. In addition, these adolescents face many situational barriers to self management including dealing with peer pressures, competing interests and family interactions. Our research has indicated that these adolescents and their families often lack adequate problem solving skills to help overcome situational barriers that can impede self- management. A comprehensive disease management intervention that includes patient, family, health provider and health system level components could greatly improve diabetes care for adolescents with T2DM. A comprehensive diabetes program needs to address medical management issues and self-management issues that occur both during and between clinic visits. An efficacious intervention that focuses on patient and family level components could have profound impacts on patients' long-term health by fostering utilization of medical services and successful resolution of barriers to self-management. However, to date, there have been no formal evaluations of comprehensive disease management interventions for this population. This proposal will enhance our previously planned randomized trial of a comprehensive disease management intervention for adolescents with T2DM. Adolescents with T2DM will be randomized to usual care versus a comprehensive intervention that includes patient, family, provider, and system level interventions to improve patient self-management, self-efficacy, A1C and other outcomes. The proposed enhancement will include an intervention to improve the situational problem solving skills of adolescents with T2DM and their caregivers. Adolescents and their caregivers will independently and collaboratively engage in Internet-based self-management problem solving learning cycles related to nutrition, exercise, glucose monitoring, and medication adherence. Peer-based interaction among adolescents with T2DM will be provided to promote solution generation and implementation, and peer support. The R03 will be an essential addition to the current K23 proposal, by: (1) allowing us to add a problem solving component to our planned intervention - a component that we feel is essential for success of the overall intervention, (2) allow us to learn about the unique role of a problem solving intervention in adolescents with T2DM, and (3) will provide valuable additional results that will be essential for seeking future R01 funding to perform additional studies to improve care for adolescents with T2DM. Type 2 diabetes is a growing problem among adolescents, particularly in minority populations. Our initial research has demonstrated that these adolescents and their families often lack adequate problem solving skills to help overcome situational barriers that can impair their ability to take care of themselves. This study will enhance our previously planned trial of a comprehensive disease management intervention for adolescents with T2DM, by adding specific Internet-based tools to improve the situational problem solving skills of adolescents with T2DM and their caregivers.