Diabetes Empowerment Council: Integrative Pilot Intervention for Transitioning Young Adults With Type 1 Diabetes

Marc J Weigensberg, Cheryl Vigen, Paola Sequeira, Donna Spruijt-Metz, Magaly Juarez, Daniella Florindez, Joseph Provisor, Anne Peters, Elizabeth A Pyatak, Marc J Weigensberg, Cheryl Vigen, Paola Sequeira, Donna Spruijt-Metz, Magaly Juarez, Daniella Florindez, Joseph Provisor, Anne Peters, Elizabeth A Pyatak

Abstract

Background: The transition of young adults with type 1 diabetes (T1D) from pediatric to adult care is challenging and frequently accompanied by worsening of diabetes-related health. To date, there are no reports which prospectively assess the effects of theory-based psycho-behavioral interventions during the transition period neither on glycemic control nor on psychosocial factors that contribute to poor glycemic control. Therefore, the overall aim of this study was to develop and pilot test an integrative group intervention based on the underlying principles of self-determination theory (SDT), in young adults with T1D.

Methods: Fifty-one young adults with T1D participated in an education and case management-based transition program, of which 9 took part in the Diabetes Empowerment Council (DEC), a 12-week holistic, multimodality facilitated group intervention consisting of "council" process based on indigenous community practices, stress-reduction guided imagery, narrative medicine modalities, simple ritual, and other integrative modalities. Feasibility, acceptability, potential mechanism of effects, and bio-behavioral outcomes were determined using mixed qualitative and quantitative methods.

Results: The intervention was highly acceptable to participants, though presented significant feasibility challenges. Participants in DEC showed significant reductions in perceived stress and depression, and increases in general well-being relative to other control participants. Reduction in perceived stress, independent of intervention group, was associated with reductions in hemoglobin A1C. A theoretical model explaining the effects of the intervention included the promotion of relatedness and autonomy support, 2 important aspects of SDT.

Conclusions: The DEC is a promising group intervention for young adults with T1D going through transition to adult care. Future investigations will be necessary to resolve feasibility issues, optimize the multimodality intervention, determine full intervention effects, and fully test the role of the underlying theoretical model of action.ClinicalTrials.gov Registration Number NCT02807155; Registration date: June 15, 2016 (retrospectively registered).

Keywords: diabetes; guided imagery; narrative medicine; stress; support group; young adults.

Figures

Figure 1.
Figure 1.
Intervention Group Assignments
Figure 2.
Figure 2.
Theoretical Model for DEC Process and Outcomes.
Figure 3.
Figure 3.
Relationship Between Change in A1C and Change in Perceived Stress.

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