Angelica Cristello Sarteau1, Jamie Crandell2,3, Michael Seid4, Jessica C Kichler4, David M Maahs5,6, Jessica Wang1, Elizabeth Mayer-Davis1,7. 1. Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina, USA. 2. School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA. 3. Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA. 4. Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, Ohio, USA. 5. Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA. 6. Stanford Diabetes Research Center and Health Research and Policy (Epidemiology), Stanford, California, USA. 7. School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
Abstract
INTRODUCTION: Youth with type 1 diabetes (T1D) commonly do not meet HbA1c targets. Youth-directed goal setting as a strategy to improve HbA1c has not been well characterized and associations between specific goal focus areas and glycemic control remain unexplored. OBJECTIVE: To inform future trials, this analysis characterized intended focus areas of youth self-directed goals and examined associations with change in HbA1c over a 18 months. METHODS: We inductively coded counseling session data from youth in the Flexible Lifestyle Empowering Change Intervention (n = 122, 13-16 years, T1D duration >1 year, HbA1c 8-13%) to categorize intended goal focus areas and examine associations between frequency of goal focus areas selected by youth and change in HbA1c between first and last study visit. RESULTS: We identified 13 focus areas that categorized youth goal intentions. Each session where youth goal setting concurrently incorporated blood glucose monitoring (BGM), continuous glucose monitoring (CGM), and insulin dosing was associated with a 0.4% (95% CI: -0.77, -0.01; P = .03) lower HbA1c at the end of intervention participation. No association was observed between HbA1c and frequency of sessions where goal intentions focused on BG only (without addressing insulin or CGM) (β: 0.07; 95% CI: -0.07, 0.21; P = .33) nor insulin dosing only (without addressing BGM or CGM) (β: 0.00; 95% CI: -0.11, 0.10; P = .95). CONCLUSIONS: Findings exemplify how guiding youth goal development and combining multiple behaviors proximally related to glycemic control into goal setting may benefit HbA1c among youth with T1D. More research characterizing optimal goal setting practices in youth with T1D is needed.
INTRODUCTION: Youth with type 1 diabetes (T1D) commonly do not meet HbA1c targets. Youth-directed goal setting as a strategy to improve HbA1c has not been well characterized and associations between specific goal focus areas and glycemic control remain unexplored. OBJECTIVE: To inform future trials, this analysis characterized intended focus areas of youth self-directed goals and examined associations with change in HbA1c over a 18 months. METHODS: We inductively coded counseling session data from youth in the Flexible Lifestyle Empowering Change Intervention (n = 122, 13-16 years, T1D duration >1 year, HbA1c 8-13%) to categorize intended goal focus areas and examine associations between frequency of goal focus areas selected by youth and change in HbA1c between first and last study visit. RESULTS: We identified 13 focus areas that categorized youth goal intentions. Each session where youth goal setting concurrently incorporated blood glucose monitoring (BGM), continuous glucose monitoring (CGM), and insulin dosing was associated with a 0.4% (95% CI: -0.77, -0.01; P = .03) lower HbA1c at the end of intervention participation. No association was observed between HbA1c and frequency of sessions where goal intentions focused on BG only (without addressing insulin or CGM) (β: 0.07; 95% CI: -0.07, 0.21; P = .33) nor insulin dosing only (without addressing BGM or CGM) (β: 0.00; 95% CI: -0.11, 0.10; P = .95). CONCLUSIONS: Findings exemplify how guiding youth goal development and combining multiple behaviors proximally related to glycemic control into goal setting may benefit HbA1c among youth with T1D. More research characterizing optimal goal setting practices in youth with T1D is needed.
Authors: Elizabeth J Mayer-Davis; David M Maahs; Michael Seid; Jamie Crandell; Franziska K Bishop; Kimberly A Driscoll; Christine M Hunter; Jessica C Kichler; Debra Standiford; Joan M Thomas Journal: Lancet Child Adolesc Health Date: 2018-07-30
Authors: Tamara S Hannon; Lisa G Yazel-Smith; Amy S Hatton; Jennifer L Stanton; Elizabeth A S Moser; Xiaochun Li; Aaron E Carroll Journal: Pediatr Diabetes Date: 2018-03-04 Impact factor: 4.866
Authors: Joni Beck; Deborah A Greenwood; Lori Blanton; Sandra T Bollinger; Marcene K Butcher; Jo Ellen Condon; Marjorie Cypress; Priscilla Faulkner; Amy Hess Fischl; Theresa Francis; Leslie E Kolb; Jodi M Lavin-Tompkins; Janice MacLeod; Melinda Maryniuk; Carolé Mensing; Eric A Orzeck; David D Pope; Jodi L Pulizzi; Ardis A Reed; Andrew S Rhinehart; Linda Siminerio; Jing Wang Journal: Diabetes Educ Date: 2018-02 Impact factor: 2.140
Authors: Tadej Battelino; Thomas Danne; Richard M Bergenstal; Stephanie A Amiel; Roy Beck; Torben Biester; Emanuele Bosi; Bruce A Buckingham; William T Cefalu; Kelly L Close; Claudio Cobelli; Eyal Dassau; J Hans DeVries; Kim C Donaghue; Klemen Dovc; Francis J Doyle; Satish Garg; George Grunberger; Simon Heller; Lutz Heinemann; Irl B Hirsch; Roman Hovorka; Weiping Jia; Olga Kordonouri; Boris Kovatchev; Aaron Kowalski; Lori Laffel; Brian Levine; Alexander Mayorov; Chantal Mathieu; Helen R Murphy; Revital Nimri; Kirsten Nørgaard; Christopher G Parkin; Eric Renard; David Rodbard; Banshi Saboo; Desmond Schatz; Keaton Stoner; Tatsuiko Urakami; Stuart A Weinzimer; Moshe Phillip Journal: Diabetes Care Date: 2019-06-08 Impact factor: 19.112
Authors: Susan M Moore; Naomi J Hackworth; Victoria E Hamilton; Elisabeth P Northam; Fergus J Cameron Journal: Health Qual Life Outcomes Date: 2013-03-22 Impact factor: 3.186