Suboptimal preparation for transition to adult care has been associated with adverse outcomes in youth with T1D. There is need for innovative curricular approaches acceptable to teens in order to optimize transition preparation and engagement. To create a feasible transition education model, we conducted 6 focus groups with teens and young adults with T1D (N=41) and 3 parent groups (N=23). Participants desired facilitated peer group education while maintaining 1:1 individualized T1D care. The Self-Management, Adherence and Readiness for Transition in T1D (SMART T1D) curriculum was derived from focus group themes and refined by a T1D Teen Advisory Committee (N=20) prior to packaging as 3 modules. Session topics included self-advocacy/adherence, T1D science education, and transition planning. Pediatric nurse specialists trained in motivational interviewing delivered SMART T1D in evening sessions over ∼9 months. Feasibility was assessed in a pilot RCT. Teens (N=40, 50% male, 85% white) with T1D were randomized to SMART T1D (N=20) or an attention control group (N=20) receiving 3 educational electronic newsletters, with both groups maintaining routine T1D care. Teens had mean±SD age 15.7±1.2 years, T1D duration 6.4±3.9 years, A1c 9.5±1.2%; 63% pump users. During the 1-year pilot RCT, we conducted 17 groups, with 1-6 teens in attendance/group (mean, median, mode=3/group); 15/20 teens attended 3 sessions, 2 attended 2 sessions, 3 attended 1 session. Review of 3 newsletters was confirmed by 19/20 controls. Only 3 teens withdrew (1 intervention, 2 control). Intervention feedback was very positive; 88% endorsed agree/strongly agree for recommending groups to other teens and 65% endorsed increased interest in transition information. Negative feedback related to scheduling/traveling to group sessions. SMART T1D was feasible and acceptable to most (95%) teens with T1D; future multi-center studies can assess portability, generalizability, and alternative virtual delivery models.


K. Garvey: None. T. Dean: None. S. Christensen: None. K. Rice: None. V.B. Rich: None. S. Terrio: None. L.M. Laffel: Advisory Panel; Self; Lilly Diabetes, Novo Nordisk A/S, Roche Diabetes Care, Sanofi. Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Janssen Pharmaceuticals, Inc., UpToDate.


National Institutes of Health

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at