Adolescents with type 1 diabetes (T1D) are at risk for poor medical and psychosocial outcomes, making the development of resiliency skills important to help these patients with T1D and elevated distress navigate stressors and achieve positive outcomes.

According to a study published in JAMA Network Open, a resilience-building program was a promising approach to improve psychosocial and behavioral outcomes among adolescents with T1D and elevated diabetes distress.¹

Background

The study investigators, led by Joyce P. Yi-Frazier, PhD, noted that youth with T1D have several management requirements that are needed to meet glycemic targets and reduce their risk of acute and long-term diabetes-related complications.¹

Yi-Frazier, of the Center for Clinical & Translational Research, Seattle Children’s Research Institute, Seattle, Washington, and the Department of Psychosocial Oncology & Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, and colleagues wrote of the negative associations of these complications:¹

"Over one-third of adolescents with T1D experience elevated diabetes distress, the emotional response associated with the burden of living with and managing this disease," wrote the study authors. "Diabetes distress is associated with poor engagement in self-management behaviors, higher hemoglobin A_1c (HbA_1c) levels, and higher risk of later medical comorbidities. The diabetes resilience model suggests that enhancing their resources may help adolescents manage stressors and achieve positive outcomes."^1,2

As a result, the authors sought to test the efficacy of the Promoting Resilience in Stress Management (PRISM) intervention on levels of HbA_1c, diabetes distress, self-management behaviors, resilience, and quality of life among adolescents, the key primary and secondary outcomes.¹

Study details and results

In a phase 3, parallel, and 1:1 randomized clinical trial, 172 participants aged 13 to 18 years with T1D for at least 12 months, at 2 children's hospitals in Seattle, Washington and Houston, Texas were included. The trial was conducted for 12 months. Patients also had elevated diabetes distress for at least 12 months.¹

The PRISM intervention program is a manualized, individual, and skill-based program that "teaches stress management, goal setting, reframing, and meaning-making, facilitated by a coach and accompanied by a digital app, was delivered in three 30- to 60-minute sessions approximately 2 weeks apart," per the study authors.¹

Baseline mean (SD) HbA_1c level of the 172 adolescents (56% female) was 8.7%. At the 6-month mark of the study, no differences were observed between PRISM and usual care (UC) recipients in HbA_1c levels (β, −0.21 [95% CI, −0.65 to 0.22]; P = .33) or diabetes distress (β, −2.71 [95% CI, −6.31 to 0.90]; P = .14) or any participant-reported outcome (eg, β, 2.25 [95% CI, −0.30 to 4.80]; P = .08 for self-management behaviors) at 6 months.¹

At 12 months, no statistically significant differences between arms in HbA_1c levels were observed (β, −0.26 [95% CI, −0.72 to 0.19]; P = .25), though PRISM recipients reported significantly greater amelioration of diabetes distress compared to UC patients (β, −4.59 [95% CI, −8.25 to −0.94]; P = .01), as well as improved self-management behaviors (β, 3.4 [95% CI, 0.9 to 5.9]; P = .01).¹

Conclusion

"These findings suggest that future research should further study resilience skills building for adolescents with T1D and diabetes distress, such as identifying optimal timing and dose to bolster the 12-month effects observed in this trial and longer-term follow-up periods to study sustained improvements and potential later effects on HbA1c values,' stated the investigative team.¹

The authors concluded while additional research is required and should focus on specific resilience skills, overall findings suggest that the strengths-based PRISM intervention, "represents a feasible and moderately efficacious approach to promote psychosocial and behavioral health benefits among adolescents with T1D and elevated diabetes distress."¹

References:

1. Yi-Frazier JP, Hilliard ME, O’Donnell MB, et al. Promoting Resilience in Stress Management for Adolescents With Type 1 Diabetes: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(8):e2428287. doi:10.1001/jamanetworkopen.2024.28287

2. Hagger V, Hendrieckx C, Sturt J, Skinner TC, Speight J. Diabetes distress among adolescents with type 1 diabetes: a systematic review. Curr Diab Rep. 2016;16(1):9. doi:10.1007/s11892-015-0694-2