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UPMC Children’s Pediatric Endocrinology Division Testing Novel Diabetes Self-Management Model in Emerging Adults Through NIH R34 Grant

March 19, 2024

A collaborative research project between the UPMC Children’s Hospital of Pittsburgh Division of Pediatric Endocrinology and the adult Division of Endocrinology and Metabolism at UPMC is testing a novel model of diabetes self-management in a cohort of emerging adults (EA).

The study, titled “Application of the Telemedicine for Reach, Education, Access, and Treatment Delivery Model to Engage Emerging Adults in Diabetes Self-Management Education and Support (TREAT-ED),” is funded by a National Institutes of Health – National Institute of Diabetes and Digestive and Kidney Disease R34 grant.

Leading the study are principal investigators Ingrid Libman, MD, PhD, professor of Pediatrics and director of the pediatric Diabetes Program at UPMC Children’s, and Linda M. Siminerio, PhD, RN, CDCES, emeritus professor of Medicine and Nursing in the adult Division of Endocrinology and Metabolism at UPMC. Also collaborating on the study are Jodi Krall, PhD, and Megan Hamm, PhD.

The study is adapting the TREAT (Telemedicine for Reach, Education, Access and Therapy) telehealth model that Dr. Siminerio and colleagues at the University of Pittsburgh originally developed in 2011 and tested in adult patients with type 2 diabetes. The TREAT-ED model has a focus on diabetes self-management and is now being tested in a population of EA – those individuals who are between the ages of 18-25 – with type 1 diabetes.

Young adults with type 1 diabetes are known to experience difficulties in optimally managing their condition as they transition to adulthood. For young adults with type 1 diabetes, assuming full responsibility for their condition and transitioning to adult health care can complicate their ability to manage their diabetes effectively.

What is the TREAT Model?

The TREAT framework is an advanced approach to diabetes care, utilizing telemedicine to make diabetes specialty care and self-management education and support more accessible to individuals with diabetes. By leveraging digital platforms, TREAT enables patients to participate in visits with an endocrinologist and educational sessions and receive support from diabetes educators remotely, breaking down barriers related to distance and scheduling. This model emphasizes personalized care, based on individual health data, and encourages active patient participation through a collaborative, multidisciplinary team of specialists. Aimed at improving patient engagement, enhancing clinical outcomes, and facilitating a supportive community, TREAT works to empower patients with better tools for managing their diabetes, ultimately aiming for improved health and quality of life.

Grant/Study Overview and Objectives – Adapting TREAT to TREAT-ED (education)

Dr. Libman and Dr. Siminerio’s research project aims to adapt the TREAT delivery model to better suit the needs of EAs with type 1 diabetes.

“This age group of individuals with diabetes is at a critical juncture of transitioning to adulthood and faces unique challenges in diabetes self-management,” says Dr. Libman. “If we can provide an evidence-based framework of support for these individuals we may be able to set them on a trajectory that will allow for optimal long-term outcomes.”

The self-management model being tested through the grant is designed to integrate key diabetes self-management objectives to foster informed decision-making, self-care practices, and a smooth transition to adult care services.

As an initial step, the team will be interviewing health care providers as well as emerging adults with T1D to discover and explore the contextual factors affecting DSMES delivery and engagement. Taking these findings from the interviews into account, the final TREAT-ED intervention will be built using human-centered design activities conducted with health care providers and emerging adults. Last, the TREAT-ED intervention will be piloted and tested with a focus on evaluating its feasibility and impact on participation, alongside assessing clinical, psychosocial, and behavioral outcomes.

By employing group telemedicine sessions led by diabetes care and education specialists (DCESs) and utilizing continuous blood glucose monitoring (CGM) reports as tailored educational tools, the study will try to overcome the traditionally low participation rates in DSMES among emerging adults.

The underlying hypothesis is that DSMES models leveraging modern technology and peer support can significantly improve engagement and outcomes for EAs at high risk of diabetes-related complications.

“If our study is successful, the TREAT-ED model could serve as a scalable framework for enhancing DSMES across a wider array of patient populations,” says Dr. Libman.

Drs. Libman and Siminerio also go on to explain that this research project is another recent opportunity for the pediatric and adult endocrinology divisions to collaborate on novel research projects that leverage the expertise and prior learnings of each group to devise novel approaches to tackling complex patient care dynamics, like self-management and education in patients with diabetes.

Grant Reference and Link

Application of the Telemedicine for Reach, Education, Access, and Treatment delivery model to engage emerging adults in Diabetes Self-Management Education and Support (TREAT-ED)

NIH Project Number: 1R34DK136020.

Other References and Reading

TREAT (Telemedicine for Reach, Education, Access, and Treatment) (TREAT). ID NCT01339208.

1. Toledo, F, Ruppert, K, Huber, K, Siminerio, L. Efficacy of Telemedicine for Reach, Education, Access and Treatment (TREAT) Model for Diabetes Care. Diabetes Care. 2014; 37: 179-80.

2. Siminerio L, Ruppert K, Huber K, Toledo F. Telemedicine for Reach, Education, Access and Treatment (TREAT): Linking telemedicine with diabetes self-management education to improve care in rural communities. The Diabetes Educator. 2014, 40-46.

3. Griffith M, Siminerio L, Payne T, Krall J. A shared decision-making approach to telemedicine: Engaging rural patients in glycemic management. J Clin Med. 5. 2016; 1-7.  5103; doi:10.3390/jcm5110103.