A Novel Miniature Equine-Assisted Diabetes Education Program for Youth: Evaluating the Diabetes Equine Empowerment Program (DEEP). (DEEP)

September 11, 2026 updated by: Jennifer Pfieffer, Nemours Children's Clinic

Tiny Hooves, Big Impact - A Feasibility Study of Miniature Equine-Assisted Diabetes Education for Children With Diabetes

The Diabetes & Equine Empowerment Program (DEEP) is a research study evaluating a novel diabetes education program that combines hands-on interactions with miniature horses and evidence-based diabetes self-management education for youth ages 8-20 years with diabetes. Participants and their caregivers attend four structured educational sessions led by a diabetes specialist and a certified equine specialist. Topics include diabetes self-management, coping skills, problem-solving, self-advocacy, and transition readiness. Researchers will evaluate whether the program is feasible to deliver, acceptable to participants and families, and helpful in supporting engagement in diabetes care. Participants will be followed for up to six months after the program, and study outcomes include satisfaction, diabetes-related distress, self-care behaviors, clinic attendance, and diabetes technology use.

In simple terms, this study is exploring whether learning about diabetes through guided activities with miniature horses can help children, adolescents, and young adults feel more confident in managing their diabetes, improve self-care skills, and become more engaged in their health care. The goal is to determine whether this innovative educational approach is practical to offer and valued by patients, families, and health care providers.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Youth with diabetes often face challenges related to self-management, problem-solving, coping with the daily demands of diabetes, and developing the skills needed for increasing independence. Innovative approaches that promote engagement and active participation may help address these challenges while supporting diabetes education and self-confidence.

The Diabetes & Equine Empowerment Program (DEEP) was developed to integrate experiential learning with diabetes education through structured interactions with miniature horses. The program is designed to create a supportive, interactive environment in which participants can practice communication, goal setting, self-advocacy, and problem-solving while reinforcing key diabetes self-management concepts. Educational content is tailored to developmental level and incorporates activities intended to enhance engagement, self-efficacy, and readiness for independent diabetes management.

This single-arm feasibility study will evaluate the implementation of the DEEP program among youth with diabetes and their caregivers. Participants will complete a series of structured sessions facilitated by a diabetes specialist and a certified equine specialist. The study will examine the practicality of recruitment strategies, participant retention, attendance, and completion of study activities. Acceptability of the intervention will be assessed through participant and caregiver feedback regarding satisfaction, perceived value, and willingness to recommend the program to others.

In addition to feasibility and acceptability outcomes, exploratory measures will assess potential changes in diabetes-related psychosocial and behavioral outcomes, including diabetes distress, self-management behaviors, healthcare engagement, and diabetes technology utilization. Data collected through participant-reported measures and medical record review will be used to inform future research and the potential development of larger controlled studies evaluating equine-assisted diabetes education interventions. Participants will be followed for up to six months after program completion.

Study Type

Interventional

Enrollment (Estimated)

50

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Age 8 to 20 years
  • Diagnosis of type 1 or type 2 diabetes
  • Most recent HbA1c greater than 9.0% OR no diabetes clinic follow-up for more than 6 months
  • English-speaking participant and caregiver
  • Receiving diabetes care at the participating study site
  • Willing and able to participate in the DEEP intervention
  • Able to attend all four study sessions
  • Able to provide informed consent/assent, as applicable
  • Caregiver willing to participate in study activities and assessments

Exclusion Criteria:

  • Non-English-speaking participant or caregiver
  • Medical, physical, cognitive, or behavioral condition that would prevent safe participation in study activities
  • Significant fear of horses that would limit participation
  • Allergy to horses that would limit participation
  • Previous participation in the DEEP intervention
  • Inability or unwillingness to complete study procedures or follow-up assessments
  • Any condition that, in the opinion of the investigators, would make participation unsafe or interfere with study completion

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Diabetes & Equine Empowerment Program (DEEP)
Participants in this single-arm intervention will receive the Diabetes & Equine Empowerment Program (DEEP), a miniature equine-assisted diabetes education program. Participants and their caregivers will attend four structured sessions led by a diabetes specialist and a certified equine specialist. Sessions combine experiential learning activities with diabetes education focused on self-management, coping skills, problem-solving, self-advocacy, and transition readiness. The study will evaluate feasibility, acceptability, participant satisfaction, and exploratory psychosocial and behavioral outcomes.
Behavioral: Diabetes & Equine Empowerment Program (DEEP)
The Diabetes & Equine Empowerment Program (DEEP) is a behavioral and educational intervention that combines evidence-based diabetes self-management education with structured, hands-on interactions involving miniature horses. Youth with diabetes and their caregivers participate in four facilitated sessions led by a diabetes specialist and a certified equine specialist. Session activities are designed to reinforce diabetes self-management skills, coping strategies, problem-solving, communication, self-advocacy, and transition readiness through experiential learning. The intervention aims to improve participant engagement, confidence in diabetes management, and readiness for increasing independence while providing a supportive and interactive learning environment. The program is being evaluated for feasibility, acceptability, participant satisfaction, and potential effects on psychosocial and behavioral outcomes.
Other Names:
  • DEEP
  • Miniature Equine-Assisted Diabetes Education

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Participant Recruitment Rate
Time Frame: From study initiation through completion of enrollment (approximately 9 months)
Recruitment feasibility will be assessed by the proportion of eligible participants who enroll in the four-session miniature equine-assisted diabetes education program, as documented in study enrollment records.
From study initiation through completion of enrollment (approximately 9 months)
Participant Retention Rate
Time Frame: From enrollment through completion of study participation (approximately 9 months)
Retention feasibility will be assessed by the proportion of enrolled participants who remain in the study and complete scheduled study assessments, as documented in study records.
From enrollment through completion of study participation (approximately 9 months)
Program Attendance Rate
Time Frame: From enrollment through completion of study participation (approximately 9 months)
Attendance feasibility will be assessed by the proportion of scheduled miniature equine-assisted diabetes education sessions attended by participants, as documented in program attendance logs.
From enrollment through completion of study participation (approximately 9 months)
Program Completion Rate
Time Frame: From enrollment through completion of study participation (approximately 9 months)
Completion feasibility will be assessed by the proportion of enrolled participants who complete all four miniature equine-assisted diabetes education sessions.
From enrollment through completion of study participation (approximately 9 months)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Diabetes Distress Assessed by the Problem Areas in Diabetes Questionnaires (PAID-C/PAID-T)
Time Frame: Baseline to immediately after completion of the four-session DEEP program
Change in diabetes-related emotional distress among youth participants as measured by the Problem Areas in Diabetes questionnaires, including the PAID-C for participants ages 8-12 years and the PAID-T for participants ages 13-17 years. Higher scores indicate greater diabetes-related distress
Baseline to immediately after completion of the four-session DEEP program
Change in Diabetes Self-Management Behaviors Assessed by the Self-Care Inventory-Updated (SCI-U)
Time Frame: Baseline to immediately after completion of the four-session DEEP program
Change in diabetes self-management behaviors as measured by the Self-Care Inventory-Updated (SCI-U), a validated self-report questionnaire that assesses adherence to diabetes self-care activities, including blood glucose monitoring, medication administration, and diabetes-related self-management tasks. Higher scores indicate better adherence to the diabetes care plan.
Baseline to immediately after completion of the four-session DEEP program
Routine Diabetes Appointment Attendance Assessed by Electronic Health Record Review
Time Frame: Six months before participation through six months after program completion
Change in routine diabetes clinic appointment attendance as assessed through electronic health record review. Attendance will be evaluated by comparing the proportion of scheduled diabetes clinic visits attended before participation and following completion of the DEEP program
Six months before participation through six months after program completion
Diabetes Technology Initiation Assessed by Electronic Health Record Review
Time Frame: Program completion through six months after program completion
The number of participants who initiate diabetes technology, including continuous glucose monitoring and/or insulin pump therapy, within six months following program completion, as documented through electronic health record review.
Program completion through six months after program completion

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Nemours Children's Clinic

Investigators

  • Study Director: Susana Patton, PhD, ABPP, CDCES, Nemours Children's Health

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

October 1, 2026

Primary Completion (Estimated)

October 1, 2027

Study Completion (Estimated)

October 1, 2028

Study Registration Dates

First Submitted

August 18, 2026

First Submitted That Met QC Criteria

September 11, 2026

First Posted (Actual)

September 16, 2026

Study Record Updates

Last Update Posted (Actual)

September 16, 2026

Last Update Submitted That Met QC Criteria

September 11, 2026

Last Verified

September 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • MOD00002923

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

IPD Plan Description

Individual participant data (IPD) sharing plans have not yet been determined. Because this is an early-stage feasibility study with a small sample size, data sharing considerations will be evaluated following completion of the study and analysis of the results. Any future sharing of de-identified data will be considered in accordance with applicable regulations, institutional policies, participant privacy protections, and informed consent provisions.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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