Background: T1D care delivery via SMA is associated with increased attendance and satisfaction in adolescents, but the impact of the model on clinical and psychosocial outcomes remains unclear.

Objective: Evaluate the efficacy of SMA for improving psychosocial outcomes in adolescents with T1D.

Methods: Participants in the prospective Team Clinic study were randomized to attend SMA or individual appointments (usual care). They completed the Children’s Depression Inventory (CDI), Problem Areas in Diabetes (PAID), Diabetes Family Conflict Scale (DFCS), and Diabetes Strengths and Resilience (D-STAR) measures at baseline and after one year.

Results: Eighty-six adolescents (51% female; 74% white; 10% Latinx) completed at least one study visit. Team Clinic participants (n = 44) attended more visits than patients in usual care (n = 42; p < 0.0001), and they attended all four study visits more frequently (66%) than those in usual care (33%). Although all adolescents reported nearly equal levels of depressive symptoms, emotional distress, and family conflict associated with diabetes care at baseline, significant differences emerged over the course of the study. Specifically, adolescents in Team Clinic reported reduced levels of conflict with family, while those in usual care reported slightly increased levels of conflict (p=0.03). Team Clinic adolescents also reported reduced depressive symptoms when compared to usual care, including more positive mood (p=0.001), greater self-esteem (p=0.03), improved effectiveness in completing daily tasks (p=0.03), and reduced anhedonia (p=0.04). Team Clinic adolescents also reported improved resilience and reduced emotional distress in diabetes care compared to controls, but these results were only marginally significant.

Conclusions: SMA may support adolescents with T1D in reducing familial conflict associated with diabetes care, while providing a decrease in comorbid depressive symptoms.


J. Raymond: Other Relationship; Self; Insulet Corporation. M.W. Reid: None. C. Berget: Consultant; Self; Insulet Corporation, Medtronic. C.L. Cain: None. B. Anderson: None. G.J. Klingensmith: Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Takeda Pharmaceutical Company Limited. Research Support; Self; Novo Nordisk Foundation. Stock/Shareholder; Spouse/Partner; Dexcom, Inc.


The Leona M. and Harry B. Helmsley Charitable Trust

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