Evaluating the feasibility of Type 1 Diabetes Education and Support (T1DES) intervention to improve diabetes distress among Black young adults

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T1DES Project Summary The proposed research focuses on the unique needs of Black young adults aged 18-26 years to address a critical gap in the research and clinical care. The goal is to test the feasibility and preliminary efficacy of a culturally adapted and tailored intervention to enhance diabetes management strategies among Black young adults with T1D, addressing the pervasive racial disparity in health outcomes for this population. OnTrack is a tested intervention that demonstrated improved outcomes (diabetes distress and HbA1c) among adults (mean age 45.1 years, SD=15.0) with T1D and elevated HbA1c. It involves highly structured, group-based sessions (facilitated by a counselor) and individual support. OnTrack had greater reductions in diabetes distress among patients with lower cognitive function or emotion regulation, higher distress, and higher diabetes knowledge at baseline. Though these baseline metrics among KPGA patients are unknown, formative work highlighting feelings of isolation, stress, and challenges with self-management render OnTrack an ideal starting place for patients with T1D. While OnTrack improved outcomes in T1D, its relevance to Black young adults has not been tested. More representative and culturally competent interventions are needed. This proposal leverages the team's expertise in developing interventions35, KP's capacity to access our virtual data warehouse to gather historical and prospective data, KPGA's proportionately large Black patient advisory board and membership with T1D, and clinical advisors from endocrinology, health education, and behavioral health. The specific aims for the 3-year study are to: Aim 1: Assess feasibility of the culturally tailored intervention T1DES by measuring intervention acceptability, demand (retention, completed > 80% of sessions), practicality, and implementation fidelity through participant surveys and key informant interviews with participants and the health care delivery team. Aim 2: Evaluate the effect of the T1DES intervention on diabetes outcomes in a pilot randomized clinical trial among N=40 Black young adults age 18-26 years with T1D and elevated HbA1c (>7.5%) by comparing changes in HbA1c, diabetes distress, and self-management from baseline to 6-months post-baseline among participants randomized to T1DES compared to the diabetes education-only control condition. We hypothesize T1DES participants will demonstrate improved HbA1c, reduced diabetes distress, and increased self- management over time compared to controls. Results will be used to generate effect sizes and support an application for larger, fully powered, longer term trial to evaluate the impact of T1DES on health outcomes and disparities. More research is critically needed on effective strategies that are both inclusive of Black young adults and tailored to their unique challenges.24 Our goal is to provide diabetes education and emotion regulation support tailored for Black young adults' experiences that will result in sustained glycemic control and can be incorporated into adult endocrinology practices.