An RCT of a family intervention for adolescents living with type 1 diabetes: Who benefits most?

AIMS: The current study sought to evaluate a family-based programme designed for adolescents with type 1 diabetes and their parents and identify which families benefited most. METHODS: A randomized controlled trial with a waitlist control with 157 parent-adolescent dyads collected data via online surveys and glycaemic measures at baseline and 3- and 6-month post-baseline. Regression models tested main and moderated effects on primary outcomes of percent time-in-range (% TIR) and diabetes health-related quality of life (HRQOL) and secondary outcomes of HbA1c and adolescent and parent diabetes distress. RESULTS: Beneficial intervention effects included improved parent report of supportive parenting (β = 0.151, p = 0.007, d = 0.31) and both parent (β = -0.177, p = 0.002, d = -0.36) and adolescent (β = -0.150, p = 0.024, d = -0.30) report of unsupportive parenting immediately after the intervention for the full sample. Improvements in HRQOL (β = 0.308, p = 0.002, d = 0.81) at 3-month post-baseline among racial and ethnic minoritized adolescents, HRQOL at 3-month (β = 0.261, p = 0.003, d = 0.94) and 6-month (β = 0.220, p = 0.005, d = 0.58) post-baseline among adolescents not using automated insulin delivery systems. The intervention also reduced parent diabetes distress among parents with high baseline distress (β = -0.200, p = 0.006, d = -0.54). CONCLUSIONS: While family dynamics improved for all, adolescents' quality of life improved among youth with fewer resources and from marginalized racial and ethnic backgrounds, whereas parents with higher distress benefited most. For adolescents, socioeconomic context may drive intervention response.