Developing a multicomponent intervention to increase glucose time in range in adolescents and young adults with type 1 diabetes: An optimisation trial to screen continuous glucose monitoring, sleep extension, healthier snacking and values-guided self-management intervention components

Abstract

Aim: The study aimed to identify active intervention components to improve glucose sensor time in range (TIR; 70–180 mg/dL [3.9–10.0 mmol/L]) by ≥5 % among adolescents and young adults (13 to 20 yrs) with type 1 diabetes and above recommended glycated haemoglobin (HbA1c ≥ 7.5 % [≥ 58 mmol/mol]), regardless of current insulin therapy. Methods: The 6-week optimisation trial used a 24 factorial experiment to estimate the main effects and interactions of the following candidate intervention components on TIR: real-time continuous glucose monitoring (CGM) technology, sleep extension, healthier snacking support, and values-guided self-management. Twenty-one participants, mean (SD) age 16.1 (2.4) years, were randomised to one of 16 experimental conditions. Results: The main effects, as measured by the mean difference (95 % CI) in TIR from baseline to 4 weeks, were: CGM, 3.3 (−8.8, 15.4) percentage points; sleep extension, −7.2 (−19.0, 4.6) percentage points; snacking support, 0.9 (−11.8, 13.5) percentage points; values-guided self-management, 6.1 (−7.5, 19.7) percentage points. Conclusions: The values-guided self-management was the only ‘active’ component. Conclusions about the less impactful intervention components are limited due to disruptions in research activities from the COVID-19 pandemic. Future work will address other candidate intervention components.