Optimizing Self-Management Adherence and Glycemic Control in Older Teens With Type 1 Diabetes: The Teenwork Study

Glycemic control deteriorates during adolescence as parents become less involved in teens' diabetes management and adherence declines. Thus, there is a need to improve adherence and glycemic control in mid to older teens with type 1 diabetes by strengthening the teens' self-efficacy for daily diabetes self-management to help prepare them for the transition between pediatric and adult care. This 18-month, multi-center RCT is designed to increase frequency of blood glucose monitoring and improve glycemic control in teens with type 1 diabetes through a behavioral intervention called Teenwork with or without text message reminders to check blood glucose levels.

We will implement and evaluate the Teenwork intervention and text message reminders to check blood glucose levels in a 2x2 factorial design in which 300 participants, across two sites, will be randomized to 1 of 4 groups: Teenwork, Text Message, Teenwork/Text Message, or Usual Care.

Participants in the Teenwork Group will meet with a research assistant during each study visit to review strategies for improving self-care, including self-management and self-advocacy, focusing on two areas: blood glucose monitoring and insulin administration. Participants in the Text Message Group will be instructed in the use of the text messaging system. They will receive 2-way text message reminders to check blood glucose levels at self-selected times and to reply by text message with blood glucose results. Participants in the Teenwork/Text Message Group will receive both the Teenwork intervention and the text message reminders (as described above). Participants in the Usual Care Group will receive the same intervention as the Teenwork/Text Message Group, but not until after 1 year.

Inclusion criteria

• Youth age 13-17 years
• Diagnosis of type 1 diabetes according to American Diabetes Association criteria
• Diabetes duration ≥6 months
• Daily insulin dose ≥0.5 units/kg
• A1c ≥6.5%and ≤11%
• Willingness to check blood glucose levels
• Cell phone with text messaging ability
• Clinic attendance

• At least one clinic visit at the clinical site in the previous 12 months
• Anticipated care at the clinical site for the duration of the study
• Fluency in English (reading, writing, and speaking) for child and parent/guardian
• Enrollment no later than December of the teen's senior year of high school

Exclusion criteria

• Pregnancy in the youth participant
• Significant developmental or cognitive disorder that would prevent full study participation
• Significant mental illness, defined by either major psychiatric disorder (e.g., diagnosed eating disorder, major psychoses) or inpatient psychiatric admission within the previous 6 months
• Failure to understand that the 2-way text messaging does NOT result in immediate response from a health care professional; this will be assessed at the time of informed consent/assent
• Participation in another intervention study within the 3 months prior to enrollment
• Other psychosocial, medical, or family issues, as assessed by the teen's pediatric team, that would prevent full study participation