A pilot trial of an intervention to support initial type 2 diabetes selfmanagement among younger adults with children. - ABSTRACT More adults are being diagnosed with type 2 diabetes (T2D) at younger ages and are at increased risk of developing micro- and macrovascular complications occurring earlier in their life courses. The year following T2D diagnosis presents a critical window in which effective behavior change interventions that lead to improved early glycemic outcomes can influence long-term diabetes-related health (i.e., the “Legacy Effect”). Fewer than half of younger adults (ages 21-44 years at diagnosis) achieve the recommended HbA1c target of <7% during the year following diagnosis, compared to 62% of individuals diagnosed later. These age-related differences in achieving early glycemic targets highlight the need for novel approaches to support behavior changes among newly diagnosed younger adults. Current T2D self-management programs are not tailored to address the distinct life demands of many younger adults, particularly the responsibility of parenting young children. Our prior qualitative work has noted that while the time and priority given to children’s needs may limit parents’ opportunities for T2D self-management, the desire to remain healthy, model healthy behaviors, and reduce children’s T2D risk may motivate healthy behavior changes. Building on this, we hypothesize that a tailored, virtually delivered, family-inclusive T2D self-management support program whose content and design are informed by common barriers and facilitators experienced by younger adults with children will lead to greater behavior changes than standard care. We used preliminary data, clinical expertise, the Capability-Opportunity-Motivation-Behavior (COM-B) behavior change framework, and Family Systems Theory to develop our program, STRIDE (SupporTing paRents with DiabEtes). STRIDE includes 3 virtual group sessions (1. Prioritizing Self-Care, 2. Eating Well Together, and 3. Getting Active as a Family) and tailored interactive text messages. In the proposed small R01, we will conduct a randomized, pilot trial of STRIDE vs. a waitlist control in adults ages 21-44 years (n=75 participants per arm) with newly diagnosed T2D who are caregivers to at least one child ages 5-14 years. Individuals allocated to the waitlist arm will be invited to participate in STRIDE after the intervention period is complete. We will assess STRIDE’s preliminary efficacy (Aim 1), specifically its impact on participants’ diabetes distress and self-efficacy, known mediators of improved glycemic control. Secondary outcomes include between-arm differences in HbA1c, medication initiation and adherence, and engagement in T2D self-care. We will use STRIDE session observations, post- intervention participant surveys, interviews with a subset of intervention participants, and interviews with the health educators and dieticians delivering STRIDE to examine the program’s implementation and explore factors that may mediate impact (Aim 2). The results of the proposed research will inform behavior change support strategies for newly diagnosed younger adults and lay the groundwork for a future, larger-scale, effectiveness trial to evaluate a refined and optimized version of STRIDE in real-world clinical care.
