Psychoeducational Messaging to Reduce Alcohol Use for College Students With Type 1 Diabetes: Internet-Delivered Pilot Trial

Background College environments promote high-volume or binge alcohol consumption among youth, which may be especially harmful to those with type 1 diabetes (T1D). Little is known about the acceptability and effectiveness of interventions targeting reduced alcohol use by college students with T1D, and it is unclear whether intervention framing (specifically, the narrator of intervention messages) matters with respect to affecting behavior change. Interventions promoted by peer educators may be highly relatable and socially persuasive, whereas those delivered by clinical providers may be highly credible and motivating. Objective The aim of this study is to determine the acceptability and impacts of an alcohol use psychoeducational intervention delivered asynchronously through web-based channels to college students with T1D. The secondary aim is to compare the impacts of two competing versions of the intervention that differed by narrator (peer vs clinician). Methods We recruited 138 college students (aged 17-25 years) with T1D through web-based channels and delivered a brief intervention to participants randomly assigned to 1 of 2 versions that differed only with respect to the audiovisually recorded narrator. We assessed the impacts of the exposure to the intervention overall and by group, comparing the levels of alcohol- and diabetes-related knowledge, perceptions, and use among baseline, immediately after the intervention, and 2 weeks after intervention delivery. Results Of the 138 enrolled participants, 122 (88.4%) completed all follow-up assessments; the participants were predominantly women (98/122, 80.3%), were White non-Hispanic (102/122, 83.6%), and had consumed alcohol in the past year (101/122, 82.8%). Both arms saw significant postintervention gains in the knowledge of alcohol’s impacts on diabetes-related factors, health-protecting attitudes toward drinking, and concerns about drinking. All participants reported significant decreases in binge drinking 2 weeks after the intervention (21.3%; odds ratio 0.48, 95% CI 0.31-0.75) compared with the 2 weeks before the intervention (43/122, 35.2%). Changes in binge drinking after the intervention were affected by changes in concerns about alcohol use and T1D. Those who viewed the provider narrator were significantly more likely to rate their narrator as knowledgeable and trustworthy; there were no other significant differences in intervention effects by the narrator. Conclusions The intervention model was highly acceptable and effective at reducing self-reported binge drinking at follow-up, offering the potential for broad dissemination and reach given the web-based format and contactless, on-demand content. Both intervention narrators increased knowledge, improved health-protecting attitudes, and increased concerns regarding alcohol use. The participants’ perceptions of expertise and credibility differed by narrator. Trial Registration ClinicalTrials.gov NCT02883829; https://clinicaltrials.gov/ct2/show/NCT02883829 International Registered Report Identifier (IRRID) RR2-10.1177/1932296819839503

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Psychoeducational Messaging to Reduce Alcohol Use for College Students With Type 1 Diabetes: Internet-Delivered Pilot Trial (Preprint)

10.2196/preprints.26418 ◽

2020 ◽

Author(s):

Lauren E Wisk ◽

Kara M Magane ◽

Eliza B Nelson ◽

Rebecca K Tsevat ◽

Sharon Levy ◽

...

Keyword(s):

College Students ◽

Type 1 Diabetes ◽

Alcohol Use ◽

Binge Drinking ◽

Pilot Trial ◽

Related Factors ◽

Web Based ◽

Behavior Change Interventions

BACKGROUND College environments promote high-volume or binge alcohol consumption among youth, which may be especially harmful to those with type 1 diabetes (T1D). Little is known about the acceptability and effectiveness of interventions targeting reduced alcohol use by college students with T1D, and it is unclear whether intervention framing (specifically, the narrator of intervention messages) matters with respect to affecting behavior change. Interventions promoted by peer educators may be highly relatable and socially persuasive, whereas those delivered by clinical providers may be highly credible and motivating. OBJECTIVE The aim of this study is to determine the acceptability and impacts of an alcohol use psychoeducational intervention delivered asynchronously through web-based channels to college students with T1D. The secondary aim is to compare the impacts of two competing versions of the intervention that differed by narrator (peer vs clinician). METHODS We recruited 138 college students (aged 17-25 years) with T1D through web-based channels and delivered a brief intervention to participants randomly assigned to 1 of 2 versions that differed only with respect to the audiovisually recorded narrator. We assessed the impacts of the exposure to the intervention overall and by group, comparing the levels of alcohol- and diabetes-related knowledge, perceptions, and use among baseline, immediately after the intervention, and 2 weeks after intervention delivery. RESULTS Of the 138 enrolled participants, 122 (88.4%) completed all follow-up assessments; the participants were predominantly women (98/122, 80.3%), were White non-Hispanic (102/122, 83.6%), and had consumed alcohol in the past year (101/122, 82.8%). Both arms saw significant postintervention gains in the knowledge of alcohol’s impacts on diabetes-related factors, health-protecting attitudes toward drinking, and concerns about drinking. All participants reported significant decreases in binge drinking 2 weeks after the intervention (21.3%; odds ratio 0.48, 95% CI 0.31-0.75) compared with the 2 weeks before the intervention (43/122, 35.2%). Changes in binge drinking after the intervention were affected by changes in concerns about alcohol use and T1D. Those who viewed the provider narrator were significantly more likely to rate their narrator as knowledgeable and trustworthy; there were no other significant differences in intervention effects by the narrator. CONCLUSIONS The intervention model was highly acceptable and effective at reducing self-reported binge drinking at follow-up, offering the potential for broad dissemination and reach given the web-based format and contactless, on-demand content. Both intervention narrators increased knowledge, improved health-protecting attitudes, and increased concerns regarding alcohol use. The participants’ perceptions of expertise and credibility differed by narrator. CLINICALTRIAL ClinicalTrials.gov NCT02883829; https://clinicaltrials.gov/ct2/show/NCT02883829 INTERNATIONAL REGISTERED REPORT RR2-10.1177/1932296819839503

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Cognitive behavioral therapy for insomnia among young adults who are actively drinking: a randomized pilot trial

SLEEP ◽

10.1093/sleep/zsaa171 ◽

2020 ◽

Author(s):

Mary Beth Miller ◽

Chelsea B Deroche ◽

Lindsey K Freeman ◽

Chan Jeong Park ◽

Nicole A Hall ◽

...

Keyword(s):

Young Adults ◽

Alcohol Use ◽

Cognitive Behavioral Therapy ◽

Binge Drinking ◽

Behavioral Therapy ◽

Pilot Trial ◽

Cognitive Behavioral ◽

Wrist Actigraphy ◽

Insomnia Severity

Abstract Study Objectives More than half of young adults at risk for alcohol-related harm report symptoms of insomnia. Insomnia symptoms, in turn, have been associated with alcohol-related problems. Yet one of the first-line treatments for insomnia (Cognitive Behavioral Therapy for Insomnia or CBT-I) has not been tested among individuals who are actively drinking. This study tested (1) the feasibility and short-term efficacy of CBT-I among binge-drinking young adults with insomnia and (2) improvement in insomnia as a predictor of improvement in alcohol use outcomes. Methods Young adults (ages 18–30 years, 75% female, 73% college students) who met criteria for Insomnia Disorder and reported 1+ binge drinking episode (4/5+ drinks for women/men) in the past month were randomly assigned to 5 weekly sessions of CBT-I (n = 28) or single-session sleep hygiene (SH, n = 28). All participants wore wrist actigraphy and completed daily sleep surveys for 7+ days at baseline, posttreatment, and 1-month follow-up. Results Of those randomized, 43 (77%) completed posttreatment (19 CBT-I, 24 SH) and 48 (86%) completed 1-month follow-up (23 CBT-I, 25 SH). CBT-I participants reported greater posttreatment decreases in insomnia severity than those in SH (56% vs. 32% reduction in symptoms). CBT-I did not have a direct effect on alcohol use outcomes; however, mediation models indicated that CBT-I influenced change in alcohol-related consequences indirectly through its influence on posttreatment insomnia severity. Conclusions CBT-I is a viable intervention among individuals who are actively drinking. Research examining improvement in insomnia as a mechanism for improvement in alcohol-related consequences is warranted. Trial Registration U.S. National Library of Medicine, https://clinicaltrials.gov/ct2/show/NCT03627832, registration #NCT03627832

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Clinical Trial Recruitment and Retention of College Students with Type 1 Diabetes via Social Media: An Implementation Case Study

Journal of Diabetes Science and Technology ◽

10.1177/1932296819839503 ◽

2019 ◽

Vol 13 (3) ◽

pp. 445-456 ◽

Cited By ~ 7

Author(s):

Lauren E. Wisk ◽

Eliza B. Nelson ◽

Kara M. Magane ◽

Elissa R. Weitzman

Keyword(s):

College Students ◽

Social Media ◽

Type 1 Diabetes ◽

Decision Rules ◽

Health Related ◽

Social Media Platforms ◽

Trial Implementation

Background: We sought to quantify the efficiency and acceptability of Internet-based recruitment for engaging an especially hard-to-reach cohort (college-students with type 1 diabetes, T1D) and to describe the approach used for implementing a health-related trial entirely online using off-the-shelf tools inclusive of participant safety and validity concerns. Method: We recruited youth (ages 17-25 years) with T1D via a variety of social media platforms and other outreach channels. We quantified response rate and participant characteristics across channels with engagement metrics tracked via Google Analytics and participant survey data. We developed decision rules to identify invalid (duplicative/false) records (N = 89) and compared them to valid cases (N = 138). Results: Facebook was the highest yield recruitment source; demographics differed by platform. Invalid records were prevalent; invalid records were more likely to be recruited from Twitter or Instagram and differed from valid cases across most demographics. Valid cases closely resembled characteristics obtained from Google Analytics and from prior data on platform user-base. Retention was high, with complete follow-up for 88.4%. There were no safety concerns and participants reported high acceptability for future recruitment via social media. Conclusions: We demonstrate that recruitment of college students with T1D into a longitudinal intervention trial via social media is feasible, efficient, acceptable, and yields a sample representative of the user-base from which they were drawn. Given observed differences in characteristics across recruitment channels, recruiting across multiple platforms is recommended to optimize sample diversity. Trial implementation, engagement tracking, and retention are feasible with off-the-shelf tools using preexisting platforms.

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Young adults with type 1 diabetes and their experiences with diabetes follow‐up and participation in the DiaPROM pilot trial: A qualitative study

Diabetic Medicine ◽

10.1111/dme.14535 ◽

2021 ◽

Cited By ~ 1

Author(s):

Ingvild Hernar ◽

Marit Graue ◽

Ragnhild B. Strandberg ◽

Silje S. Lie ◽

Arun K. Sigurdardottir ◽

...

Keyword(s):

Type 1 Diabetes ◽

Young Adults ◽

Qualitative Study ◽

Pilot Trial

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Type-1 Diabetes Management and Alcohol Use: A Qualitative Analysis of Lived Experiences and Strategies of College Students

Journal of Adolescent Health ◽

10.1016/j.jadohealth.2017.11.201 ◽

2018 ◽

Vol 62 (2) ◽

pp. S99

Author(s):

Shannon L. Wilson ◽

Kelly Palmer ◽

David G. Marrero ◽

Brett M. McKinney ◽

Nathan W. Stupiansky

Keyword(s):

College Students ◽

Type 1 Diabetes ◽

Alcohol Use ◽

Qualitative Analysis ◽

Lived Experiences ◽

Diabetes Management

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MyDiaText™: Feasibililty and Functionality of a Text Messaging System for Youth With Type 1 Diabetes

The Diabetes Educator ◽

10.1177/0145721719837895 ◽

2019 ◽

Vol 45 (3) ◽

pp. 253-259 ◽

Cited By ~ 3

Author(s):

Tara Kaushal ◽

Kathleen A. Montgomery ◽

Reid Simon ◽

Kelly Lord ◽

Jennifer Dougherty ◽

...

Keyword(s):

Type 1 Diabetes ◽

User Satisfaction ◽

Text Messaging ◽

Pilot Trial ◽

Text Message ◽

Text Messages ◽

Support Tool ◽

Reading Text

Purpose The purpose of this study was to determine the feasibility and functionality of MyDiaText™, a website and text messaging platform created to support behavior change in adolescents with type 1 diabetes (T1DM) and to evaluate user satisfaction of the application. Methods This study was a nonrandomized, prospective, pilot trial to test the feasibility and user interface with MyDiaText, a text message system for 10- to 17-year-old youths with newly diagnosed T1DM. Feasibility was evaluated by assessing for the user’s ability to create a profile on the website. Functionality was defined by assessing whether a subject responded to at least 2 text messages per week and by their accumulating points on the website. User satisfaction of the text messaging system was assessed using an electronic survey. The 4 phases of this study were community engagement—advisory sessions, screening and enrollment, intervention, and follow-up. Results Twenty subjects (14 male, 6 female) were enrolled. All subjects were able to create a profile, and of these, 86% responded to at least 2 text messages per week. A survey administered during follow-up showed that users enjoyed reading text messages, found them useful, and thought the frequency of messages was appropriate. Conclusion MyDiaText is a feasible, functional behavioral support tool for youth with T1DM. Users of the application reported high satisfaction with text messages and the reward system.

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Insulin Resistance-Related Factors, but not Glycemia, Predict Coronary Artery Disease in Type 1 Diabetes: 10-year follow-up data from the Pittsburgh Epidemiology of Diabetes Complications study

Diabetes Care ◽

10.2337/diacare.26.5.1374 ◽

2003 ◽

Vol 26 (5) ◽

pp. 1374-1379 ◽

Cited By ~ 291

Author(s):

T. J. Orchard ◽

J. C. Olson ◽

J. R. Erbey ◽

K. Williams ◽

K. Y.-Z. Forrest ◽

...

Keyword(s):

Insulin Resistance ◽

Coronary Artery Disease ◽

Type 1 Diabetes ◽

Coronary Artery ◽

Diabetes Complications ◽

Related Factors ◽

Artery Disease

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Motivational Interviewing and Glycemic Control in Adolescents With Poorly Controlled Type 1 Diabetes: A Randomized Controlled Pilot Trial

Frontiers in Endocrinology ◽

10.3389/fendo.2021.639507 ◽

2021 ◽

Vol 12 ◽

Author(s):

Anna-Kaisa Tuomaala ◽

Matti Hero ◽

Martti T. Tuomisto ◽

Maria Lähteenmäki ◽

Päivi J. Miettinen ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Motivational Interviewing ◽

Pilot Trial ◽

Glycemic Variability ◽

Randomized Controlled ◽

Standard Education ◽

One Year

A multicenter randomized controlled pilot trial investigated whether motivational interviewing (MI) by diabetes physicians improves glycemic control and variability in the context of follow-up for adolescent patients with poorly controlled type 1 diabetes. Patients (n = 47) aged 12 to 15.9 years who showed poor glycemic control (HbA1c >75 mmol/mol/9.0%) were randomized to standard education (SE) only or MI+SE, with study physicians randomized to employ MI+SE (N = 24 patients) or SE only (N = 23). For one year of follow-up, the main outcome measurements were obtained at three-month visits (HbA1c) or six-monthly: time in range (TIR) and glycemic variability (CV). Mean adjusted 12-month change in HbA1c was similar between the MI+SE and SE-only group (-3.6 vs. -1.0 mmol/mol), and no inter-group differences were visible in the mean adjusted 12-month change in TIR (-0.8 vs. 2.6%; P = 0.53) or CV (-0.5 vs. -6.2; P = 0.26). However, the order of entering the study correlated significantly with the 12-month change in HbA1c in the MI+SE group (r = -0.5; P = 0.006) and not in the SE-only group (r = 0.2; P = 0.4). No link was evident between MI and changes in quality of life. The authors conclude that MI’s short-term use by diabetes physicians managing adolescents with poorly controlled type 1 diabetes was not superior to SE alone; however, improved skills in applying the MI method at the outpatient clinic may produce greater benefits in glycemic control.

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