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. 2024 Apr 9:9:e55165.
doi: 10.2196/55165.

Moderating Effect of Depression on Glycemic Control in an eHealth Intervention Among Black Youth With Type 1 Diabetes: Findings From a Multicenter Randomized Controlled Trial

Deborah Ellis  1 , April Idalski Carcone  1 , Thomas Templin  2 , Meredyth Evans  3   4 , Jill Weissberg-Benchell  3   4 , Colleen Buggs-Saxton  5 , Claudia Boucher-Berry  6 , Jennifer L Miller  7 , Tina Drossos  8 , M Bassem Dekelbab  9
Affiliations

Moderating Effect of Depression on Glycemic Control in an eHealth Intervention Among Black Youth With Type 1 Diabetes: Findings From a Multicenter Randomized Controlled Trial

Deborah Ellis et al. JMIR Diabetes. .

Abstract

Background: Black adolescents with type 1 diabetes (T1D) are at increased risk for suboptimal diabetes health outcomes; however, evidence-based interventions for this population are lacking. Depression affects a high percentage of youth with T1D and increases the likelihood of health problems associated with diabetes.

Objective: Our aim was to test whether baseline levels of depression moderate the effects of a brief eHealth parenting intervention delivered to caregivers of young Black adolescents with T1D on youths' glycemic control.

Methods: We conducted a multicenter randomized controlled trial at 7 pediatric diabetes clinics located in 2 large US cities. Participants (N=149) were allocated to either the intervention group or a standard medical care control group. Up to 3 intervention sessions were delivered on a tablet computer during diabetes clinic visits over a 12-month period.

Results: In a linear mixed effects regression model, planned contrasts did not show significant reductions in hemoglobin A1c (HbA1c) for intervention adolescents compared to controls. However, adolescents with higher baseline levels of depressive symptoms who received the intervention had significantly greater improvements in HbA1c levels at 6-month follow-up (0.94%; P=.01) and 18-month follow-up (1.42%; P=.002) than those with lower levels of depression. Within the intervention group, adolescents had a statistically significant reduction in HbA1c levels from baseline at 6-month and 18-month follow-up.

Conclusions: A brief, culturally tailored eHealth parenting intervention improved health outcomes among Black adolescents with T1D and depressive symptoms.

Trial registration: ClinicalTrials.gov NCT03168867; https://clinicaltrials.gov/study/NCT03168867.

Keywords: T1D; adolescents; black; depression; eHealth; family intervention; randomized clinical trial; randomized controlled trial; type 1 diabetes.

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Conflict of interest statement

Conflicts of Interest: JLM’s spouse is a majority owner of Element Bars, Inc, a snack bar company. The other authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
The CONSORT (Consolidated Standards of Reporting Trials) flow diagram.
Figure 2
Figure 2
Sample intervention content for The 3Ms.
Figure 3
Figure 3
Hemoglobin A1c (HbA1c) trajectories by intervention group from baseline to 18 months.
Figure 4
Figure 4
Hemoglobin A1c (HbA1c) trajectories by the Patient-Reported Outcome Measurement Information System Pediatric Short Form Depressive Symptoms (PROMIS-D): depressive symptoms low to moderate (<23) versus high (≥23). The high cut-point was 1 SD above the PROMIS-D scale mean at baseline. In the high depressive symptom subgroup, the drops in HbA1c from baseline to 6 months and from baseline to 18 months were significant (P<.05).
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