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Cited by 15Diabetes Management and EducationTelemedicine and Telehealth ImplementationDiabetes Management and Research

A nonrandomized pilot of a group, video-based telehealth intervention to reduce diabetes distress in parents of youth with type 1 diabetes mellitus

Open access
Patton, Susana R., Monzon, Alexandra D., Marker, Arwen M., Clements, Mark A.·2022·Canadian Journal of Diabetes
DOI 10.1016/j.jcjd.2021.10.007PMC PMC9107594
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Abstract

Objectives Our aim in this study was to refine and pilot a video-based telehealth intervention to reduce diabetes distress, depressive symptoms and hypoglycemia fear in parents of school-age children with type 1 diabetes and to assess for changes in child glycated hemoglobin (A1C).Methods We recruited 41 parents of children (5 to 12 years) to participate in a manualized, video-based telehealth intervention (Cognitive Adaptions to Reduce Emotional Stress [CARES]). Of these, 29 parents completed either a 12-week (n=13) or 8-week (n=16) version of CARES based on the timing of their recruitment. We assessed feasibility (i.e. attrition, attendance) and parent satisfaction with CARES. We used repeated-measures analysis of variance with parent group (8 vs 12 sessions) as a between-subject variable and time as a within-subject variable to measure change in our dependent variables.Results Mostly mothers participated (97.3%). Parents' mean age was 39.65±6.84 years and children's mean age was 9.86±1.57 years at pretreatment. CARES had low attrition (20% to 25%) and good attendance (96% to 98%). Parents also reported high levels of treatment satisfaction (>85%). There were significant main effects for time for parent-reported diabetes distress and depressive symptoms at posttreatment and 3-month follow-up. There was a statistical trend suggesting a time × group interaction for parent depressive symptoms at posttreatment. There was a significant main effect for time for hypoglycemia fear at the 3-month follow-up but no change at posttreatment. There was no change in child A1C at posttreatment.Conclusion CARES showed high parent satisfaction, good feasibility and promising results for reducing diabetes distress in parents of school-age children with type 1 diabetes.

Integrity signals

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Crossref · 10.1016/j.jcjd.2021.10.007

Cites

32 of 32 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 31 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Parents reported significant reductions in diabetes distress (d=1.13, p<0.001) pre-treatment to three-months follow-up.

    “Again, consistent with our primary hypothesis, parents reported significant reductions in diabetes distress (d= 1.13, p<0.001) pre-treatment to three-months follow-up.”
    Quote in the paperSubstantial claim
  • Findingown data

    Parents reported significant reductions in depressive symptoms (d=0.22, p=0.02) pre- to post-treatment.

    “Parents also reported significant reductions in depressive symptoms (d=0.22, p=.0.02) pre- to post-treatment”
    Quote in the paperNot a substantial claim
  • Findingown data

    Parents reported significant reductions in diabetes distress (d=0.88, p<0.001) pre- to post-treatment.

    “Consistent with our primary hypothesis, parents reported significant reductions in diabetes distress (d=0.88, p<001) pre- to post-treatment.”
    Quote in the paperSubstantial claim
  • Findingown data

    Of 17 families initially assigned to 12-session CARES, 13 completed treatment and the three-months follow-up (24% attrition rate).

    “Of the 37 families who enrolled, we initially assigned 17 families to complete our 12-session CARES and of these, 13 families completed treatment and the three-months follow-up (24% attrition rate).”
    Quote in the paperSubstantial claim
  • Findingown data

    Parents who completed the 12-session CARES reported a total satisfaction score of 68.54±5.8, or 91.4% satisfaction.

    “Parents who completed the 12-session CARES reported a total score of 68.54±5.8, or 91.4% satisfaction”
    Quote in the paperSubstantial claim
  • May combine two claims. 12
  • Classified as probably not a substantial claim. 16

  • May combine two claims.

    Findingnone given

    Of 41 families approached, 37 enrolled, and 29 completed treatment (21% attrition).

    “Overall, we approached 41 families, 37 families enrolled, and 29 completed treatment (21% attrition).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    There was no significant main effect for time or a time × group interaction for child HbA1c pre- to post-treatment.

    “We also did not find a significant main effect for time or a time × group interaction for parents’ HFS-P total scores or child HbA1c.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of 20 families initially assigned to 8-session CARES, 16 completed treatment (20% attrition rate) and 15 completed the three-months follow-up (25% attrition).

    “We initially assigned 20 families to complete our 8-session CARES and of these, 16 families completed treatment (20% attrition rate) and 15 completed the three-months follow-up (25% attrition).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    There was no significant main effect for time or a time × group interaction for parents' HFS-P total scores pre- to post-treatment.

    “We also did not find a significant main effect for time or a time × group interaction for parents’ HFS-P total scores or child HbA1c.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most participants were mothers (97.3%).

    “Mostly mothers participated (97.3%).”
    • Also stated in: § Results · plain
      “Most participants were mothers.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For parents who started treatment, attendance at group sessions ranged from 96-98% with no difference for parents participating in the 8- or 12-session CARES.

    “For parents who started treatment, attendance at group sessions ranged from 96–98% with no difference for parents participating in the 8- or 12-session CARES.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The daily management of type 1 diabetes is arduous and time-consuming.

    “The daily management of type 1 diabetes is arduous and time-consuming [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] 2020, 13. Children and adolescents: Standards of medical care in diabetes---2020, Diabetes Care

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Adolescence is a period when sub-optimal type 1 diabetes treatment engagement and glycemia can begin to occur and low parental involvement can exacerbate these outcomes.

    “Adolescence is a period when sub-optimal type 1 diabetes treatment engagement and glycemia can begin to occur and low parental involvement can exacerbate these outcomes [10].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] King, 2012, Longitudinal trajectories of metabolic control across adolescence: Associations with parental involvement, adolescents' psychosocial maturity, and health care utilization, J Adolesc Health source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The present sample had a Cronbach's alpha level of 0.87 for PAID-PR.

    “The present sample had a Cronbach’s alpha level of 0.87.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    CESD-R is a validated 20-item measure of depressive symptoms occurring within the last two weeks.

    “Center for Epidemiological Studies Depression Scale-Revised (CESD-R) [22] is a validated 20-item measure of depressive symptoms occurring within the last two weeks.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] Radloff, 1977, The CES-D scale, Appl Psychol Meas source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A key difference of the ORBIT model versus other approaches is its focus on using small, fluid, and cost-effective formative studies to develop and refine interventions ahead of launching expensive efficacy trials.

    “A key difference of the ORBIT model versus other approaches is its focus on using small, fluid, and cost-effective formative studies to develop and refine interventions ahead of launching expensive efficacy trials [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Czajkowski, 2015, From ideas to efficacy: The ORBIT model for developing behavioral treatments for chronic diseases, Health Psychol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Between 20-33% of parents of school-age youth with type 1 diabetes endorse diabetes distress.

    “despite recent data suggesting between 20–33% of parents of school-age youth with type 1 diabetes endorse diabetes distress [4, 5].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4] Evans, 2019, Psychometric properties of the parent and child problem areas in diabetes measures, J Pediatr Psychol source

      Not checked in the free run.

    • cites [5] Noser, 2019, Parental depression and diabetes-specific distress after the onset of type 1 diabetes in children, Health Psychol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    HFS-P is a validated 25-item parent-report measure of hypoglycemia fear.

    “The HFS-P is a validated 25-item parent-report measure of hypoglycemia fear.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Shepard, 2014, Understanding the construct of fear of hypoglycemia in pediatric type 1 diabetes, J Pediatr Psychol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Children's HbA1c levels were analyzed in a central laboratory using automated high performance liquid chromatography with methods reliable to DCCT standards.

    “We analyzed children’s HbA1c levels in a central laboratory using automated high performance liquid chromatography with methods reliable to Diabetes Control and Complications Trial (DCCT) standards (Reference range 4.0–6.0%; Tosoh 2.2, Tosoh Corporation, San Francisco, CA) [24].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Khuu, 1999, Evaluation of a fully automated high-performance liquid chromatography assay for hemoglobin A1c, Arch Pathol Lab Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The present sample had a Cronbach's alpha level of 0.92 for CESD-R.

    “The present sample had a Cronbach’s alpha level of 0.92.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The ORBIT model defines four phases of treatment development.

    “The ORBIT model defines four phases of treatment development.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Czajkowski, 2015, From ideas to efficacy: The ORBIT model for developing behavioral treatments for chronic diseases, Health Psychol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Parents' Cronbach's alpha level was 0.90 for HFS-P for the study.

    “parents’ Cronbach’s alpha level was 0.90 for the study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Children's HbA1c was measured using a validated fingerstick mail-in kit.

    “We used a validated fingerstick mail-in kit at pre- and post-treatment to measure children’s HbA1c.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study obtained institutional review board approval prior to study initiation and registered the pilot at ClinicalTrials.gov (NCT03698708).

    “We obtained institutional review board approval prior to study initiation and registered the pilot at ClinicalTrials.gov (NCT03698708).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The ORBIT model provides a progressive and iterative approach for developing and testing new interventions.

    “The ORBIT model was first introduced in 2015 and provides a progressive and iterative approach for developing and testing new interventions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Czajkowski, 2015, From ideas to efficacy: The ORBIT model for developing behavioral treatments for chronic diseases, Health Psychol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Power calculations suggested 80% power for large effect sizes (0.80) and n=15 at a two-tailed alpha of 0.05.

    “Power calculations suggested 80% power for large effect sizes (0.80) and n=15 at a two-tailed alpha of 0.05.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Diabetes distress can include diabetes-specific behavioral symptoms that can directly relate to higher glucose levels and increase the risk for future health complications.

    “Diabetes distress can also include diabetes-specific behavioral symptoms such as suboptimal treatment engagement or maladaptive coping strategies (e.g., guessing an insulin dose to avoid checking glucose) that can directly relate to higher glucose levels and increase the risk for future health complications [3–5].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [3] Pallayova, 2014, Targeting diabetes distress: The missing piece of the successful type 1 diabetes management puzzle, Diabetes Spectr source

      Not checked in the free run.

    • cites [4] Evans, 2019, Psychometric properties of the parent and child problem areas in diabetes measures, J Pediatr Psychol source

      Not checked in the free run.

    • cites [5] Noser, 2019, Parental depression and diabetes-specific distress after the onset of type 1 diabetes in children, Health Psychol source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationcitation

    Per the ORBIT model, evidence of achieving these milestones indicates a treatment may be appropriate for Phase 2 proof of concept or randomized pilot testing.

    “Per the ORBIT model, evidence of achieving these milestones indicate a treatment may be appropriate for Phase 2 proof of concept or randomized pilot testing. [13]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13] Czajkowski, 2015, From ideas to efficacy: The ORBIT model for developing behavioral treatments for chronic diseases, Health Psychol source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The study was underpowered to detect a significant change in child HbA1c due to small sample size and because CARES participation was not restricted to parents of children with elevated HbA1c levels.

    “It is possible that we were underpowered to detect a significant change in child HbA1c due to our small sample size and because we did not restrict CARES participation only to parents of children with elevated HbA1c levels.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Results suggest initial feasibility for the CARES intervention and high levels of parent satisfaction.

    “Our results suggest initial feasibility for the CARES intervention and high levels of parent satisfaction.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The 15-item Treatment Satisfaction Survey validly measures parent satisfaction with the intervention.

  • May combine two claims.

    Interpretationown data

    CARES showed high parent satisfaction, good feasibility, and promising results for reducing diabetes distress in parents of school-age children with type 1 diabetes.

    “CARES showed high parent satisfaction, good feasibility, and promising results for reducing diabetes distress in parents of school-age children with type 1 diabetes.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The 15-item Treatment Satisfaction Survey validly measures parent satisfaction with the intervention.

  • May combine two claims.

    Interpretationreasoning

    The study had a relatively small sample size, which introduces the possibility that some changes in outcomes were not observed because of limited power.

    “we recognize that this study recruited a relatively small sample size, which introduces the possibility that we did not observe some changes in outcomes because of limited power.”
    Quote in the paperSubstantial claim
27 of 27

  • The paper relies on this without support.

    To date there are no interventions specifically targeting diabetes distress in parents of younger children with type 1 diabetes.

    “In addition, to date there are no interventions specifically targeting diabetes distress in parents of younger children with type 1 diabetes, despite recent data suggesting between 20–33% of parents of school-age youth with type 1 diabetes endorse diabetes distress [4, 5].”

  • The paper relies on this without support.

    The 15-item Treatment Satisfaction Survey validly measures parent satisfaction with the intervention.

    “We used a 15-item Treatment Satisfaction Survey to rate satisfaction with the intervention on a 5-point Likert scale (1= not at all to 5= very or a lot).”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Patton et al.'s telehealth intervention effectively reduced diabetes distress and depression in parents of school-aged children with type 1 diabetes posttreatment and maintained reductions after 3 months.

    “The intervention utilizes an array of psychological techniques, including cognitive-behavioural therapy, acceptance and commitment therapy, behavioural activation and mindfulness strategies to effectively reduce diabetes distress and depression posttreatment and maintain reductions after 3 months.”

    From Life With Diabetes Does Not Occur in a Vacuum: Considering Mental Health (2022) · cites this paper as [11]

    The Methods (Intervention) describe the four named techniques, and the Discussion reports significant reductions in parental diabetes distress and depressive symptoms after treatment that were maintained at three months. But the Discussion calls the results promising and notes that this small, nonrandomized pilot had no control group; it does not establish that the intervention effectively caused those reductions. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Majidi S, Noser A, Youngkin E, et al. Long-term associations between parental depression and diabetes distress in the two-years following child-onset of type 1 diabetes. In: 45th Annual International Society for Pediatric and Adolescent Diabetes Conference, 2019, Boston, MA.

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Related

Authors
Patton, S. R., Monzon, A. D., Marker, A. M., & Clements, M. A.
Affiliations
  • The University of Kansas Health System (US)
  • University of Kansas (US)
  • Children's Mercy Hospital (US)
Corresponding author
Patton, Susana R.
ORCID
Venue
Canadian Journal of Diabetes
Publisher
Elsevier BV
Published
2022-04
Volume
46
Issue
3
Pages
262-268
ISSN
1499-2671 (ISSN-L)
DOI
10.1016/j.jcjd.2021.10.007
PMC
PMC9107594
OpenAlex
W3209910218
Cited by
15
References
32
Citations by year
2026: 3 · 2025: 2 · 2024: 5 · 2023: 2 · 2022: 3
FWCI
1.87
Type
journal article
Language
en
Open access
Licence
Locations
  • Canadian Journal of Diabetes (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK100779)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
type 1 diabetes, diabetes distress, parents of children with diabetes, telehealth intervention, video-based intervention, group intervention, fear of hypoglycemia, depressive symptoms, HbA1c, CARES, feasibility, treatment satisfaction, elementary school students
MeSH terms
Adolescent, Adult, Child, Diabetes Mellitus, Type 1, Glycated Hemoglobin, Humans, Hypoglycemia, Middle Aged, Parents, Telemedicine

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