High Risk Youth With Poorly-controlled Diabetes

It has been well established through The Diabetes Control and Complications Trial (DCCT) and
its follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) studies that
achieving lower hemoglobin A1c (HbA1c) levels are associated with the delay and prevention of
long-term complications of T1DM (1, 2). Management of T1DM involves adherence to a complex,
labor-intensive regimen of subcutaneous insulin treatment, close glucose monitoring, accurate
calculation of carbohydrate intake, and adjustment of dosing and dietary regimen to account
for physical activity.

Recent technological advances including insulin pumps with auto-insulin-adjusting features
along with continuous glucose monitoring systems have allowed for individuals with T1DM to
achieve tighter diabetes control. However, despite these advances in glucose monitoring and
insulin delivery systems, the majority of children and adolescents fail to optimize their
diabetes control and are unable to achieve these targets.

Several studies have shown that adolescents in poor diabetes control are more likely to come
from a racial minority background, have lower annual household income, and be publicly
insured. In addition, these patients are also more likely to have missed medical appointments
and have less stable home environments. Thus, increased efforts and innovative programs are
needed to overcome additional barriers faced by youth with T1DM from disadvantaged
backgrounds with the goal of improving the delivery of diabetes care for our most vulnerable,
at-risk youth population.

The objective of this pilot and feasibility project is to implement a clinic-based group
education program targeting teens with poorly controlled diabetes, focusing on peer group
interaction and education combined with social media support to increase engagement and
promote behavioral change to improve glycemic control.

This study utilizes 1) group education sessions (6 total sessions over the course of 9
months), 2) online social media group forums, 3) questionnaires to assess self-care habits in
diabetes management and quality of life, and 4) surveys to assess this program.

Patients will be included in closed, private Facebook, Snapchat, and Instagram groups where
members can communicate with each other and where biweekly updates, reminders, and messages
of encouragement relevant to the previous topic covered at group sessions can be sent to the
group. Online group forums will be moderated by a staff member to ensure that message content
is appropriate and to avoid misinformation or questionable patient-to-patient medical advice.

Inclusion Criteria:

1. Between ages 13-18 (at the time of consent) with diagnosis of T1DM

2. HbA1c >9% and/or episode of DKA within the past year (other than at diagnosis)

3. Residence in a zip code associated with lower socioeconomic status (SES)

4. Possession of a device capable of accessing online social media platforms

Exclusion criteria:

1. Non-English speaking

2. Diagnosed with a developmental or psychological condition that would prevent
assumption of self-care responsibilities