AHEAD Program May Improve Diabetes Distress Among Young Adults with T1D

Faisal Malik, MD

Credit: Seattle Children's

The Achieving Health in Emerging Adults with Diabetes (AHEAD) Program may improve diabetes distress in emerging adults with type 1 diabetes (T1D), according to new research.¹

The findings, presented at the 83rd Scientific Sessions of the American Diabetes Association (ADA 2023), showed improvements in Problem Areas in Diabetes – Teen Surgery (PAID-T) scores in the patient population with the use of the program, indicating improvements in diabetes distress.

“The AHEAD program offers a promising approach to reduce diabetes distress in emerging adults with T1D,” wrote the investigative team, led by Faisal Malik, MD, from the department of pediatrics at the University of Washington and Seattle Children’s Research Institute.

Literature has shown elevated diabetes distress is increasingly prevalent in emerging adults with T1D and has been associated with higher hemoglobin A1c levels.² The AHEAD program is centered on the self-determination therapy of motivation and is designed to meet the diabetes self-management, psychosocial, and healthcare transition needs of the population. The objective of the analysis was to evaluate the impact of the AHEAD program on diabetes distress in the population of emerging adults with T1D.

The AHEAD program utilizes multidisciplinary team visits to meet the needs of emerging adults with T1D. AHEAD consists of 4 steps: tailored education based on self-identified gaps in diabetes knowledge and self-management on the Transition Readiness Assessment in Emerging Adults with Diabetes Diagnosed in Youth (READDY) tool; identifying and addressing psychological comorbidities through integrated mental health screening and care provided by an embedded AHEAD Program psychologist; supporting health care transition needs by delivering health care navigation education by an embedded AHEAD Program social worker; structuring multidisciplinary team visits to support a gradual transfer of responsibilities from the caregiver to the emerging adult with T1D.

Diabetes distress was evaluated using the Problem Areas in Diabetes – Teen survey (PAID-T), with a range of 14 - 84 and elevated diabetes distress (≥44). Investigators used mixed-effects linear regression with a random effect for individual to account for repeated measures to evaluate the change in diabetes distress over time. Models were adjusted for age, race, ethnicity, diabetes technology use, and health insurance. Investigators assessed whether improvement varied by age, diabetes technology use, health insurance, or baseline elevated diabetes distress.

The study sample included 285 emerging adults with T1D with a baseline PAID-T evaluation and ≥1 follow-up PAID-T evaluation in a single-arm study. At the baseline visit, the study sample had a mean age of 19.4 years and were 55% male and 73% non-Hispanic White. In the sample, 26% of participants had public insurance, 66% used a continuous glucose monitor, 60% used an insulin pump, and 19% had elevated diabetes distress.

Upon analysis, the findings showed overall mean PAID-T scores for the AHEAD program participants decreased from 31.8 (95% CI, 30.2 - 33.3) at baseline to 26.2 by Visit 6 (95% CI, 22.8 - 29.6). Data showed the mean adjusted PAID-T scores for the AHEAD program participants with elevated diabetes distress at baseline (PAID-T ≥44) decreased significantly from a baseline of 56.0 (95% CI, 53.4 - 58.6) to 35.5 (95% CI, 28.7 - 42.4) by Visit 6.

Investigators noted PAID-T improvement did not vary by age, diabetes technology use, or health insurance (all P >.05).

References

1. Malik FS, Hirsch IB, Pihoker C, Roberts AJ, Taplin CE, Lowry S, Yi-Frazier, Moss A, Huang A, Ehrhardt N, Hoch K, Weaver KW. Improving Diabetes Distress in Emerging Adults with T1D: The AHEAD Program. Poster presentation at the 83rd Scientific Sessions of the American Diabetes Association. June 23 – 26, 2023
2. Sattoe J, Peeters M, Bronner M, et alTransfer in care and diabetes distress in young adults with type 1 diabetes mellitusBMJ Open Diabetes Research and Care 2021;9:e002603. doi: 10.1136/bmjdrc-2021-002603