AzTrials
AzTrials

Self-regulationNCT03688919

Adolescent Interventions to Manage Self-regulation of T1D (AIMS T1D)

A study testing Self-Regulation Intervention in people with Self-regulation and Medication Adherence, run by University of Michigan at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

This goal of this project is to test whether self-regulation assays and interventions can be delivered and change self-regulation in a sample of adolescents, specifically to test in a small randomized clinical trial (RCT) whether self-regulation interventions lead to change in medication adherence. Read more about this study

Who is it for?
Ages 13 to 17 years
Conditions the study is for
Self-regulation, Medication Adherence
What is being tested?
Self-Regulation Intervention
Could I receive a placebo?
No, everyone receives an active treatment
How many people
88 participants
Where
1 siteUnited States
Study dates
13 May 2019to 31 Aug 2021
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 13 to 17 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • youth must have been diagnosed with T1D for at least 6 months;
  • reside with a parent;
  • have HbA1c>=7.0;
  • regular access to WiFi; and
  • feel comfortable speaking English enough to complete study activities; and

Who cannot join

  • non-fluency in English in parent or youth;
  • psychiatric or cognitive conditions (e.g., clinically significant depression assessed via phone screen at intake) that would impede ability to participate.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • University of Michigan

    Ann Arbor, Michigan, 48109

Other trials in United States

About this study

Official title: Targeting Self-regulation to Promote Adherence and Health Behaviors in Children

This goal of this project is to test whether self-regulation assays and interventions can be delivered and change self-regulation in a sample of adolescents, specifically to test in a small randomized clinical trial (RCT) whether self-regulation interventions lead to change in medication adherence. The study will focus on adolescents with Type 1 Diabetes (T1D). These youth have clear medication adherence goals, yet are often non adherent and at great health risk during this developmental period. As responsibility for diabetes management shifts from parent to youth during this time, intervening with adolescents directly is vital for prevention.

Read the detailed description

The goal of this study is to test whether interventions change self-regulation (SR) targets most relevant for medication adherence in youth with Type 1 Diabetes (T1D). Poor self-regulation has been identified in youth with T1D and is proposed as a central mechanism contributing to high rates of nonadherence and thus long-term complications, in pediatric T1D populations, particularly adolescents. As responsibility for T1D management shifts from parent to youth during this time, addressing self-regulation in adolescence is critical.

The study's self-regulation targets are executive functioning (EF; working memory, inhibitory control); emotion regulation (ER; capacity to manage stress, worry), and future orientation (FO; capacity to focus on future goals). The investigators posit that these self-regulation capacities are critical in order to engage in the multiple adherence behaviors (e.g., self-monitoring blood glucose, administering insulin via daily injections or a pump, regulating carbohydrate intake, physical activity, minimizing hyper-/hypo-glycemia) youth must follow to achieve and maintain optimal glycemic control. Thus, in addition to targeting T1D-specific adherence, it is essential to employ an experimental medicine approach to test whether improving self-regulation results in improved adherence behaviors and T1D-related health outcomes (quality of life; HbA1C). Yet, these self-regulation targets have not been rigorously tested as mechanisms of behavior change to improve adherence to T1D regimens in youth.

Using previously developed multimethod assays of these targets, the investigators will test the impact of interventions on these self-regulation targets, medical regimen adherence behaviors, and diabetes-related health outcomes (quality of life; HbA1C) in youth. The Scientific Premise is that poor self-regulation underlies poor medical regimen adherence. If improving self-regulation targets increase adherence in youth with T1D this approach may apply to other youth who must manage medical regimens. Findings will thus not only inform understanding of self-regulation as a mechanism of behavior change but will generate novel intervention strategies that may have trans-diagnostic implications and broad impact. As interventions to be delivered are designed to be light-touch and scalable, they may yield useful tools to use in future studies of behavior change mechanisms. The investigators propose an RCT design to test the following Specific Aims in a sample of youth with T1D (ages 13-17 years, n=94):

Aim 1. Test the hypothesis that the interventions developed in a prior study (NCT03060863) enhance identified self-regulation targets (EF, ER, FO) in a population of adolescents with T1D.

Aim 2. Test whether interventions improve medical regimen adherence behaviors and T1D health outcomes.

Exploratory Aim. Examine whether parents' SR modifies the effects of the UH3's bundled intervention to improve youth SR on youth treatment regimen adherence.

Being tested
Self-Regulation Intervention
Keywords
adolescents, Type 1 Diabetes
Medical subject headings
Self-Control, Medication Adherence, Diabetes Mellitus, Type 1

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Self-Regulation InterventionBehavioural

    The intervention targets Executive Functioning (EF), Emotion Regulation (ER) and Future Orientation (FO). The intervention will occur through home practice and text based reminders and mobile apps to practice techniques. For EF, youth will use the NBack intervention, a computer-based working memory training game. For ER, participants will engage in relaxation and biofeedback activities by completing activities (e.g., modulating breathing to keep heart rate) while wearing sensors. For FO, participants will envision and describe future events they are looking forward to, using concrete, vivid descriptive language. These descriptions will be audio recorded so that the participant can play back the cues at home at specified times of day (e.g., 7am and 3:30PM).

Study groups in NCT03688919
Study groupRoleWhat they receive
ComparisonNo interventionAdolescents and their families in this group will not receive any of the interventions.
Self-Regulation InterventionExperimentalThis arm will use a computer-based working memory training game (NBack) targeting Executive Functioning and in-person relaxation and biofeedback training targeting Emotion Regulation. As well, adolescents will receive Future Orientation training by being asked to envision and describe future events they are looking forward to, using concrete, vivid descriptive language.
Receives: Behavioral: Self-Regulation Intervention

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change From Baseline in Youth Executive Function (Behavioral EF) at 8 Weeks (Z-score)

    Behavioral EF will be measured using standard tasks (Forward/Backward Digit Span, Go No Go). In Digit Span, subjects repeat numbers presented aloud in order or reverse order (8 questions of 2 trials each; correct response is 1 point; incorrect or no response is 0 points). Scores are summed for each trial; maximum total raw score is 16 points. In Go No Go, subjects hit a key to respond when they see the 'go' stimulus (presented for 300 ms) but not when they see the no-go stimulus. Go No Go responses are scored based on reaction time (seconds) and accuracy (0-100%). Then, we will generate a composite variable indicating better EF (i.e. correct Digit Span responses, faster/more accurate Go No Go responses) by creating standardized z-scores for each task variable and calculating a mean score. The final variable analyzed will be the composite z-score that represents behavioral EF, scored such that higher scores indicate better EF and with a Z-score of 0 representing the population mean.

    Measured: baseline and 8 weeks

  2. Change From Baseline in Youth Executive Function (EF-report by Parent and Self) at 8 Weeks (Z-score)

    Youth EF-report will be assessed using parent- and self-report versions of The Behavior Rating Inventory of Executive Functioning, 2nd Edition (BRIEF-2), a standardized EF measure. Items assess ability to control impulses, pay attention, modulate responses, and anticipate events. Three broad indices are calculated (Behavior Regulation, or ability to control behavioral impulses; Emotion Regulation, or ability to control emotional reactions; and Cognitive Regulation, or ability to focus, pay attention, stay organized) and combined to form a Global Executive Composite (GEC) score, which is a standardized score representing overall EF difficulty (range 0-100). Youth and parent GEC scores are averaged to represent overall Global Executive Functioning. The final variable analyzed will be the composite z-score that combines youth- and parent-reported EF, scored such that higher scores indicate poorer EF and with a Z-score of 0 representing the population mean.

    Measured: baseline and 8 weeks

  3. Change From Baseline in Youth Emotion Regulation (ER-report by Parent and Self) at 8 Weeks (Z-score)

    ER will be measured using a composite measure of parent- and self-reports on the NIH Toolbox Perceived Stress Survey, a 10-item measure of stress in children (items are summed to indicate greater perceived stress; range: 0-40); youth self-reports of dysregulated affect using a 6-item scale based on the Structured Interview for Disorders of Extreme Stress (SIDES Affect Dysregulation Scale; items are averaged to indicate more affect dysregulation, range: 1-6); and youth reports of emotion experiences on the 20-item Positive and Negative Affect Schedule (PANAS; items are summed to indicate more negative [10 items] and fewer positive experiences [10 items]; range: 10-50). The composite ER measure will be created by standardizing and averaging PSS, SIDES, and PANAS scores. The final variable analyzed will be this composite z-score that represents ER, scored such that higher scores indicate worse ER and with a Z-score of 0 representing the population mean.

    Measured: baseline and 8 weeks

  4. Change From Baseline in Youth Self-Efficacy (Parent- and Self-reported) at 8 Weeks (Z-score)

    Youth self-efficacy is hypothesized to promote future-oriented thinking, and is thus an aspect of Future Orientation that will be measured using a composite of the NIH Toolbox Self-Efficacy parent report form and the self-report form. Both forms consist of 10 items. Participants respond to questions about their child's or their own (in the case of the child) self-efficacy. Mean scores are generated; higher scores are indicative of greater perceived self-efficacy. The final variable analyzed will be the composite z-score that represents youth self-efficacy based on parent and youth report, standardized and averaged and scored such that higher scores indicate better Self-efficacy and with a Z-score of 0 representing the population mean.

    Measured: baseline and 8 weeks

  5. Change From Baseline in Youth Future Orientation (Self-report) at 8 Weeks (Z-score)

    Considering the future and how one's actions can affect future consequences is an aspect of youth Future Orientation (FO) that will be measured using the Consideration of Future Consequences Scale. Youth will answer 14 questions (e.g., "I think about how things would be in days to come, and try to influence those things in my daily behavior") on a 7-point scale ranging from 1=Not at all like me to 7=Neutral. Higher scores indicate a greater consideration of future consequences or forward looking behavior. The final variable analyzed will be a z-score that represents self-reported FO, scored such that higher scores indicate better FO and with a Z-score of 0 representing the population mean.

    Measured: baseline and 8 weeks

  6. Change From Baseline in Youth Future Orientation (Objective Measure) at 8 Weeks (Z-score)

    The degree to which one discounts the future is an aspect of youth Future Orientation (FO) that will be objectively measured using 5-trial Delay Discounting Task. Each 5-trial version of this task uses one monetary amount per trial (e.g., $1, 000; $1, 000, 000). Participants are asked on the first trial of the task whether they would prefer to receive that amount in three weeks or half that amount now. On the next trial the question is repeated but with a different time delay according to response on the previous trial. That is, a greater delay is presented on the next trial if the participant chose "now" on the previous trial, whereas a lesser delay is presented if the participant chose the later time on the previous trial. The dependent measure is the steepness of the delay discounting curve. The final variable analyzed will be the z-score that represents this discount rate; higher scores indicate poorer FO and with a Z-score of 0 representing the population mean.

    Measured: baseline and 8 weeks

Secondary outcomes (3)
  1. Change From Baseline in Number of Participants Conducting Blood Glucose Monitoring at 8 Weeks

    Change in blood glucose monitoring (BGM) frequency will be assessed by downloading data from the prior two weeks from the adolescent's glucometer. Adherence to BGM is defined as an average of 4 blood glucose measurements/day. Note, we had missing data for the downloads due to changes in clinical care since this measure was proposed (only 30% of the sample had only meters so were not recommended by their provider to download their meters in this way; 70% of the sample had Continuous Glucose Monitors (CGM). Thus, we used the data from self-reported monitoring or CGM use, measured by youth self-report on a Type 1 Diabetes adherence measure administered to all patients in the clinic that has been linked to HbA1c level (Lee et al., 2021).

    Measured: baseline and 8 weeks

  2. Change From Baseline in in Number of Participants With Insulin Administration Adherence at 8 Weeks

    Insulin administration adherence is defined as at least 3 short acting insulin boluses/day vs not. This is measured by youth self-report on a Type 1 Diabetes adherence measure administered to all Type 1 Diabetes patients in the clinic and has been linked to Hemoglobin A1c (HbA1c), an indicator of blood glucose level (Lee et al., 2021).

    Measured: baseline and 8 weeks

  3. Change From Baseline in Self-Care Inventory Revised at 8 Weeks (Z-score)

    The Self-Care Inventory Revised (SCI-R) is a 14-item youth- and parent-report measure of multiple T1D self-care adherence behaviors. Items reflect main aspects of the T1D regimen, including: monitoring and recording glucose, administering and adjusting insulin, regulating meals and exercise, and keeping appointments. Respondents report on adherence behaviors on a 5-point scale (1="never do it"; 5="always do this as recommended without fail"; or N/A.). The final variable analyzed will be the composite z-score that represents SCI-R adherence based on youth and parent reports, standardized and averaged and scored such that higher scores indicate better adherence and with a Z-score of 0 representing the population mean.

    Measured: baseline and 8 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted28 Sep 2018
  2. Study start13 May 2019
  3. Primary completion31 Aug 2021
  4. Study completion31 Aug 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
88 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03688919
Sponsor's protocol ID
UH3HD087979
Other IDs
UH3HD087979
Status last verified
Sep 2022
First submitted
18 Sep 2018
Last updated
7 Oct 2022
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: All individual participant data (IPD) that underlie results in a publication would be made available upon reasonable request.

Publications

  • Choe A, Fredericks EM, Albright D, Lee JM, Sturza JM, Riley HO, Kaciroti N, Bauer KW, Miller AL. Executive Functioning, Diabetes Distress, and Diabetes Management Among Adolescents With Type 1 Diabetes: Youth and Parent Perspectives. Pediatr Diabetes. 2025 Feb 27;2025:7036544. doi: 10.1155/pedi/7036544. eCollection 2025.

    PubMed 40303942
  • Miller AL, Lo SL, Albright D, Lee JM, Hunter CM, Bauer KW, King R, Clark KM, Chaudhry K, Kaciroti N, Katz B, Fredericks EM. Adolescent Interventions to Manage Self-Regulation in Type 1 Diabetes (AIMS-T1D): randomized control trial study protocol. BMC Pediatr. 2020 Mar 7;20(1):112. doi: 10.1186/s12887-020-2012-7.

    PubMed 32145739

Questions about this trial

What is this clinical trial studying?

A study testing Self-Regulation Intervention in people with Self-regulation and Medication Adherence, run by University of Michigan at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 7 Oct 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 7 Oct 2022). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change From Baseline in Youth Executive Function (Behavioral EF) at 8 Weeks (Z-score) (time frame: baseline and 8 weeks). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03688919, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Oct 2022.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in