Improving Self-Regulation and Social Support for Type 1 Diabetes During Emerging Adulthood

PROJECT SUMMARY
Type 1 diabetes (T1D) is a significant public health problem, with some three million Americans living with the
illness. Although extensive research has examined factors that facilitate or impede T1D management during
childhood and adolescence, much less is known about the high-risk time of emerging adulthood. Less than
one-third of emerging adults engage in self-management consistent with recommendations for blood glucose
checking and diet, and only 17% meet recommendations for blood glucose control, placing emerging adults at
risk for serious long-term complications. We theorize these risks occur because emerging adults are still
developing the self-regulation skills to manage T1D independently and lack the necessary social resources to
manage their illness as parental involvement declines and new relationships at work and in college occur.
There is a critical need to intervene, however, few high-quality interventions exist to address the unique needs
of emerging adults with T1D. The scientific premise is that an intervention targeting self-regulation (setting
goals, planning) and social-regulation (disclosing to others so they can provide social support) will be beneficial
for meeting the challenges of managing T1D during emerging adulthood. The research is innovative in testing
the efficacy of a theory-based intervention to target self-regulation and leverage social relationships in the daily
lives of a sample of ethnically/racially diverse emerging adults. FAMS-T1D is a newly adapted intervention
based on a highly effective intervention (FAMS-Family/friend Activation to Motivate Self-Care) developed for
adults with type 2 diabetes (T2D) that involves three components: 1) phone-based coaching to improve
patients’ skills in goal pursuit and managing social relationships, 2) text messaging to patients to facilitate self-
regulation and social-regulation, and 3) text messaging to a support person (SP) to improve dialogue with and
support for the patient. The study compares the intervention to control (enhanced treatment as usual).
Extensive preliminary data of the investigative team support the need for the intervention in emerging adults
with T1D and the efficacy of the intervention for adults with T2D. In Aim 1, we evaluate the effects of the 6-
month intervention on A1c, self-management, and diabetes distress at 6-, 9-, and 12-months post baseline with
a diverse sample of 280 emerging adults and SPs recruited across two sites. In Aim 2, we examine whether
the effects on outcomes occur through improvements in patients’ reports of self-regulation (planning, self-
efficacy, self-regulation failures) and social-regulation (disclosure to others; helpful and harmful involvement of
family and friends). In Aim 3, we evaluate how the intervention improves SP reports of their involvement
without increasing SP burden. In Aim 4, we explore the time course of intervention effects on time in range
using continuous glucose monitoring data from a subsample of participants. The intervention has the potential
for high impact and broad reach as it helps emerging adults with T1D develop skills that can be leveraged in
multiple social settings, new relationships, and across other domains of life.

Grant Number: 5R01DK124719-04
NIH Institute/Center: NIH
Principal Investigator: Cynthia Berg