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Diabetes Mellitus, Type 1IDEANCT04066959

Improving Diabetes in Emerging Adulthood

A study testing Motivational Enhancement System (MES), Question Prompt List (QPL) and Text Message Reminders (TXT) in people with Diabetes Mellitus, Type 1, run by Wayne State University 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
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Trial summary

This project will test the efficacy of a multi-component behavioral intervention to improve metabolic control among older adolescents and emerging adults (16-21) with T1D, a group with chronic poor metabolic control. Read more about this study

Who is it for?
Ages 16 to 25 years
Conditions the study is for
Diabetes Mellitus, Type 1
What is being tested?
Motivational Enhancement System (MES), Question Prompt List (QPL) and Text Message Reminders (TXT)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
113 participants
Where
1 siteUnited States
Study dates
16 Nov 2020to 13 Jan 2025
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 16 to 25 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Age 16 years, 0 months - 25 years, 11 months
  • Type 1 diabetes (T1D)
  • HbA1c ≥7.5% currently and averaged over the previous 6 months
  • Duration of diabetes ≥6 months
  • English fluency, both verbal and written
  • Cell phone access with texting capability

Who cannot join

  • Psychosis (e.g., schizophrenia or bipolar disorder)
  • Suicidal
  • Developmental delay (moderate or severe mental retardation, or autism) or reading level below sixth grade
  • The presence of another physical health condition that results in atypical diabetes management (e.g., cystic fibrosis)

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Detroit Medical Center

    Detroit, Michigan, 48201

Other trials in United States

About this study

Official title: Improving Diabetes Health in Emerging Adulthood Through an Autonomy Supportive Intervention

This project will test the efficacy of a multi-component behavioral intervention to improve metabolic control among older adolescents and emerging adults (16-21) with T1D, a group with chronic poor metabolic control. This intervention is grounded in self-determination theory which states that a youth who believes their diabetes management is self-directed, competent, and supported by others is more likely to consistently complete their diabetes self-care. This theory-driven intervention will be scalable to a variety of chronic illness contexts and the knowledge gained from this research will inform self-determination theory and different interventions targeting this population (currently there are no interventions that directly target emerging adults).

Read the detailed description

This project will use the multiphase optimization strategy (MOST) approach to test the efficacy of an autonomy supportive behavioral intervention to improve metabolic control among older adolescents and emerging adults (16-25) with T1D. Youth this age demonstrate chronic poor metabolic control that persists into adulthood leading to the premature emergence of short- and long-term diabetes complications. Developmentally, adolescence and emerging adulthood is a time when the need for independence and autonomy are particularly salient. This new intervention will leverage youths' desire for autonomy by designing an intervention to support diabetes self-management autonomy. This intervention is guided by self-determination theory (SDT) which suggests that autonomous (i.e., self-initiated, driven by intrinsic versus extrinsic motivation) diabetes management depends upon three conditions: 1) the perception that one's behavior is self-directed, 2) feelings of competence, or self-efficacy, and 3) the existence of caring relationships supportive of the behavior. The investigators have identified three intervention components that target the SDT constructs. A question prompt list (QPL) is a simple, inexpensive tool comprised of a list of questions that patients might consider asking their health care provider during a clinic visit. QPLs empower patients to assume a more active role (asking questions and stating concerns) during clinic visits. The Motivation Enhancing System (MES) is an eHealth intervention to increase intrinsic motivation for health behavior change. MES content is based on the Motivational Interviewing (MI) framework and the Information-Motivation-Behavioral Skills (IMB) model of health behavior change which posits that behavior change results from the joint function of three critical components: accurate information about risk behaviors or their replacement health behaviors, motivation to change behavior, and behavioral skills necessary to perform the behavior (self-efficacy). Text message reminders (TXT) are a strategy to encourage youth to complete their diabetes self-care that also lead to gains in self-efficacy and a stronger relationship with diabetes care providers through greater communication and satisfaction. The investigators will test the efficacy of these intervention components toward improving metabolic control in a component selection experiment (N=320). The experiment will use a full factorial research design with random assignment to determine which intervention components contribute to a clinically significant improvement (≥0.5%) in HbA1c. The result of this research will be an optimized, multi-component intervention with effect size estimates that will be used to inform a large scale, fully powered effectiveness trial. This theory-driven intervention will be scalable to a variety of chronic illness contexts and the knowledge gained from this research will inform self-determination theory and behavioral interventions targeting this population (for which there currently are none).

Being tested
Motivational Enhancement System (MES), Question Prompt List (QPL), Text Message Reminders (TXT)
Keywords
emerging adults, ehealth intervention, diabetes, diabetes management, adolescents, self-determination theory
Medical subject headings
Diabetes Mellitus, Type 1, Diabetes Mellitus

What participants receive

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

  • Motivational Enhancement System (MES)Behavioural

    MES is a brief eHealth intervention delivered via an internet-based software application. MES is grounded in the Motivational Interviewing framework and the Information-Motivation-Behavioral Skills model of health behavior change. The goal of MES is to increase motivation to complete daily diabetes care tasks. MES consists of two 20-minute sessions that integrate psychoeducation with motivation-enhancing therapeutic exercises and behavioral goal setting.

  • Question Prompt List (QPL)Behavioural

    A QPL is a list of questions related to the physical and psychosocial aspects of diabetes and treatment that youth may want to ask their physicians during a clinic visit. The theoretical foundation for the QPL resides in social-cognitive theory which posits that behavioral performance is a function of self-efficacy and behavioral expectations. Thus, the goal of a QPL is to increase self-efficacy and active participation in clinical care. QPL is completed within 14-days of a diabetes clinic visit and results in a personalized set of questions for youth to bring to their clinic visit.

  • Text Message Reminders (TXT)Behavioural

    TXT is a behavioral support strategy composed of one-way text message reminders to promote daily diabetes care task completion. TXT is supported by social cognitive theory which suggests that consistent task completion leads to perceptions of control and supports goal attainment. TXT may also foster a stronger relationship with diabetes care providers through greater communication and satisfaction. Youth will receive daily reminders to complete key diabetes care tasks.

Study groups in NCT04066959
Study groupRoleWhat they receive
Question Prompt List (QPL)ExperimentalA QPL is a simple, inexpensive communication tool that is comprised of list of questions related to the physical and psychosocial aspects of an illness and treatment components about which patients may want to ask their diabetes care team during a routine diabetes clinic visit.
Receives: Behavioral: Question Prompt List (QPL)
Motivation Enhancement System (MES)ExperimentalMES is a brief, 2-session computer-delivered intervention to enhance intrinsic motivation for behavior change. MES is grounded in the Motivational Interviewing framework and the Information-Motivation-Behavioral Skills model of health behavior change. Session 1 begins with psychoeducation describing optimal diabetes self-management, then youth motivation for diabetes self-management is assessed and followed by exercises designed to increase or reinforce his/her current motivational state (e.g., decisional balance) and build self-efficacy, (e.g., building on strengths and past success). Session 1 concludes with goal setting to promote autonomous diabetes self-management. Session 2 begins with an assessment of progress toward the behavioral goal and proceeds to build motivation and self-efficacy with exercises consistent with the youth's current motivational state. Session 2 concludes with goal setting to promote autonomous diabetes self-management.
Receives: Behavioral: Motivational Enhancement System (MES)
Text Message Reminders (TXT)ExperimentalParticipants will receive 30 days of one-way text messages targeting one of three key daily diabetes care behaviors: monitoring blood glucose, insulin administration, or carbohydrate counting. Participants will set a reminder schedule, i.e., frequency and timing of text message reminders.
Receives: Behavioral: Text Message Reminders (TXT)
QPL & MESExperimentalParticipants will receive the QPL and MES interventions as described above.
Receives: Behavioral: Motivational Enhancement System (MES); Behavioral: Question Prompt List (QPL)
QPL & TXTExperimentalParticipants will receive the QPL and TXT interventions as described above.
Receives: Behavioral: Question Prompt List (QPL); Behavioral: Text Message Reminders (TXT)
MES & TXTExperimentalParticipants will receive the MES and TXT interventions as described above.
Receives: Behavioral: Motivational Enhancement System (MES); Behavioral: Text Message Reminders (TXT)
MES, QPL & TXTExperimentalParticipants will receive the MES, QPL, and TXT interventions as described above.
Receives: Behavioral: Motivational Enhancement System (MES); Behavioral: Question Prompt List (QPL); Behavioral: Text Message Reminders (TXT)
Standard Medical CareNo interventionParticipants will receive standard medical care at one of two participating clinical sites. Clinical practices at these sites are consistent with the standards of T1D care recommended by the American Diabetes Association and will include diabetes clinic visits every 3-4 months for routine diabetes medical care provided by an endocrinologist and/or nurse practitioner.

What is being measured

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

  1. Hemoglobin A1c

    Hb1Ac will be obtained by using the Accubase A1c test kit.

    Measured: Baseline/0 month, Treatment End/3 months, and Follow Up/6 months

Secondary outcomes (1)
  1. Diabetes Management Scale

    The Diabetes Management Scale (DMS) is a self-report measure of diabetes illness management assessing a broad range of diabetes management behaviors, including insulin management, dietary management, blood glucose monitoring, and symptom response with good internal consistency (α=.74 to .84). Ten items ask "What percent of the time do you (diabetes care task)?" with a response scale of 0-100% where higher scores indicate greater (better) diabetes management. A total score, ranging form 0-100%, is obtained by calculating the average response across ten items to reflect overall management behavior.

    Measured: Baseline/0 month, Treatment End/3 months, and Follow Up/6 months

Timeline

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

  1. First posted26 Aug 2019
  2. Study start16 Nov 2020
  3. Primary completion13 Jan 2025
  4. Study completion13 Jan 2025

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
Treatment
Allocation
Randomised
Intervention model
Factorial
Model description
The study will use an 8-arm full factorial design. In arms 1-3 participants will receive 1 of the 3 intervention components, arms 4-6 receive a combination of 2 components, arm 7 receives all 3 components, and arm 8 is the standard care control. The study will use the mixed effects linear model for the ANOVA of a factorial design powered on the main effects to identify the intervention components that significantly contribute to a clinically significant improvement in HbA1c. Each model will include a random intercept and slope and fixed effects for treatment combinations and time, as well as the stratification variable. The component selection experiment will result in empirical evidence supporting the efficacy of an autonomy support intervention composed of one or more components to improve metabolic control.
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
113 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04066959
Sponsor's protocol ID
R01DK116901
Other IDs
1R01DK116901-01A1
Acronym
IDEA
Status last verified
Apr 2026
First submitted
24 Jul 2019
Last updated
5 May 2026
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Ellis DA, Carcone AI, Buggs-Saxton C, Bhan A, Dekelbab MB. Effects of individual, health system and neighborhood risks on diabetes health outcomes among emerging adults with type 1 diabetes. Diabetes Res Clin Pract. 2025 Sep;227:112415. doi: 10.1016/j.diabres.2025.112415. Epub 2025 Aug 7.

    PubMed 40782842
  • Idalski Carcone A, Holtz BE, Reardon M, Vesey D, Ellis DA, Parks M. Meeting the Needs of Emerging Adults With Type 1 Diabetes Living in a Rural Area With Mobile Health Interventions: Focus Group Study. JMIR Form Res. 2024 Aug 7;8:e55650. doi: 10.2196/55650.

    PubMed 39110496
  • Idalski Carcone A, Baskar D, Mahmood A, MacDonell K, Eggly S, Ghosh S, Buggs-Saxton C, Ondersma SJ, Ellis DA. Developing eHealth Interventions to Improve Diabetes Management in Emerging Adulthood: Qualitative Formative Study. JMIR Form Res. 2025 Nov 27;9:e75623. doi: 10.2196/75623.

    PubMed 41313164
  • Idalski Carcone A, Ellis DA, Eggly S, MacDonell KE, Ghosh S, Buggs-Saxton C, Ondersma SJ. Improving Diabetes Management in Emerging Adulthood: An Intervention Development Study Using the Multiphase Optimization Strategy. JMIR Res Protoc. 2020 Oct 20;9(10):e20191. doi: 10.2196/20191.

    PubMed 33079068

Questions about this trial

What is this clinical trial studying?

A study testing Motivational Enhancement System (MES), Question Prompt List (QPL) and Text Message Reminders (TXT) in people with Diabetes Mellitus, Type 1, run by Wayne State University 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 6 inclusion and 4 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 5 May 2026. 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 5 May 2026). 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?

Hemoglobin A1c (time frame: Baseline/0 month, Treatment End/3 months, and Follow Up/6 months). 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 NCT04066959, which also lists 4 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 5 May 2026.

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