PRISM for Adolescents With Type 1 Diabetes
PRISM for Adolescents With Type 1 Diabetes
It is well-known that adolescents with type 1 diabetes are at high risk for elevated
 diabetes-specific distress and poor glycemic control. This randomized controlled trial uses a
 novel, person-centered intervention designed to reduce diabetes distress and improve
 resilience skills, which the investigators hypothesize will in turn improve glycemic control
 and quality of life. If successful, results will greatly inform future research and clinical
 strategies aimed at improving outcomes among adolescents with type 1 diabetes.
Adolescents with type 1 diabetes (T1D) are at high risk for elevated diabetes distress, which
 greatly impacts their adherence, glycemic control (A1C), and overall quality of life (QOL). A
 potential barrier to improving these experiences may be that adolescents have few
 opportunities to develop the personal resources needed to handle adversity and manage stress.
 The "Promoting Resilience in Stress Management" (PRISM) intervention is a manualized, brief,
 skills-based intervention delivered in 2, 45-60 minute one-on-one sessions, followed by a
 family meeting and supplemented by booster sessions and a digital app. PRISM was developed
 from Stress and Coping theory and targets skills in stress-management and mindfulness,
 goal-setting, positive reframing, and meaning-making. All of these skills are associated with
 improved patient outcomes in diverse groups of adolescent populations with chronic/serious
 illness, and findings from a feasibility trial in adolescents with T1D showed PRISM to be
 highly feasible and desirable in this population. Further, a recent pilot randomized
 controlled trial among adolescents with cancer suggest PRISM is associated with improved
 perceptions of resilience, lower psychological distress, and higher QOL. This application
 proposes to build on our prior experience and fill three critical knowledge gaps: (1) PRISM's
 impact on A1C among adolescents with T1D; and (2) PRISM's impact on diabetes distress,
 self-reported adherence, and other patient-reported outcomes including resilience and QOL.
 This funding opportunity seeks to test interventions targeting diabetes distress for impact
 on glycemic control. Thus, the investigators propose a multi-site randomized controlled trial
 among N=160 adolescents (n=80 PRISM, n=80 Usual Care; ages 13-18) with the primary trial
 outcome of glycemic control 6-months post-enrollment. Time-in-range will be evaluated for
 participants on continuous glucose monitors as an exploratory aim. Secondary outcomes will
 include diabetes-distress, and patient-reported adherence, resilience, and quality of life.
 The investigators hypothesize PRISM will promote better glycemic control and improved
 diabetes distress than usual care. This application offers an opportunity to expand the body
 of knowledge regarding methodologically rigorous and evidence-based interventions for
 adolescents with T1D. Ultimately, this research has the potential to offer a practical,
 skills-based curriculum designed to improve outcomes for this high-risk group.
Inclusion Criteria:

 -  • They are 13-18 years old

 -  Diagnosed with T1D >12 months

 -  Most recent A1C >=8.0%

 -  Elevated distress score (PAID-T>=44)*****

 -  Speak English fluently

 -  Cognitively able to participate in intervention sessions and complete written
 surveys.

 Exclusion Criteria:

 -  Patient refusal to participate (any age), or parental refusal to participate for
 patients less than 18 years of age

 -  Cognitively or physically unable to participate

 -  Patient unable to speak in the English language

 -  Patient unable to read in the English or Spanish language

 -  Adolescent is ward of state