Adapting an Adolescent Weight Management Program for a Type 1 Diabetes Population

Obesity was rare in youth with type 1 diabetes (T1D) prior to the 1990s, but the prevalence now exceeds that of youth in the general population. Recent studies indicate that over 50% of youth with T1D will develop overweight/obesity within five years of diagnosis. Obesity and T1D are individually associated with risks for cardiovascular disease, and combined, those risks are amplified. Intensive health behavior and lifestyle treatments (IHBLTs) are evidence-based, first-line treatments for pediatric obesity. Yet, there are unique challenges associated with managing T1D that require thoughtful adaptations to these IHBLTs. Challenges include needing to eat regardless of hunger to treat hypoglycemia, blood glucose changes making physical activity difficult, and recommended "free foods" that are high in saturated fats. Adolescents with T1D are also at high risk of developing disordered eating behaviors. There is a critical need for IHBLTs that address barriers specific to T1D and incorporate attention to eating disorder prevention in this at-risk population. Based upon multiple rounds of qualitative feedback from adolescents with T1D, their caregivers, and pediatric endocrinologists, our team developed the Type 1 Diabetes Adolescents for healthier Lifestyles (T1DAL) Study. The objective of this study is to test whether the T1DAL program preliminarily improves adolescents' health and wellbeing compared to a usual care control group.

In this study, approximately 50 total adolescents will be randomly assigned either to the T1DAL program or to Usual Care. Adolescents randomized to the T1DAL program will complete a 16-week IHBLT adapted to a T1D population. Those randomized to Usual Care will attend their routine endocrinology appointments. At the end of the study, those assigned to Usual Care will be offered an abbreviated T1DAL program. All adolescents' height, weight, time in target blood glucose range (70-180mg/dL), eating behaviors, diabetes management behaviors, and mood will be assessed at the start and end of study involvement. Participants will also complete ecological momentary assessments (EMA) at the start and end of study involvement to determine potential events of maladaptive eating and weight control behaviors over time. Exploratory analyses will evaluate correlates of these maladaptive eating and weight control behaviors in real-world settings.

This project builds upon Dr. Warnick's prior work in pediatric obesity and T1D. The proposed project aligns with the NIDDK's mission to mitigate diabetes-related cardiovascular events and has the potential to be an important public health intervention to improve the health of adolescents with T1D.