Skip to main content

Advertisement

SpringerLink
Log in

Developing and Evaluating Behaviour Change Interventions for People with Younger-Onset Type 2 Diabetes: Lessons and Recommendations from Existing Programmes

  • Psychosocial Aspects (SS Jaser, Section Editor)
  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

People with younger-onset type 2 diabetes (YOT2D, diagnosis before 40 years of age) are at higher risk of morbidity and premature mortality compared with their similar-age type 1 diabetes and later-onset type 2 diabetes peers. Despite recommendations for targeted, behavioural, and psychosocial approaches to optimising health outcomes, there are few such interventions for this group. Furthermore, evaluations of health behaviour change interventions targeting this priority population have proven challenging to complete. Despite this, there is little guidance for future behavioural programme developers. The aims of this paper are to synthesise lessons learned and recommendations from published evaluations of YOT2D-focused health behaviour change interventions, and illustrate challenges and solutions using case studies from our own experience. A rapid review of the literature identified 11 trials of behavioural interventions for YOT2D (5 randomised controlled trials, 6 pre/post studies). We sourced related needs assessment and development papers to describe the life course of each programme. We identified two development and two evaluation-related themes impacting successful trial execution. Development recommendations include ensuring appropriate adaptation of existing interventions to the unique challenges and characteristics of the target group, use of theory or theoretical frameworks throughout, and involvement of the priority population and key stakeholders from inception. Evaluation recommendations include planning for meaningful evaluation and development of age-appropriate Core Outcomes Sets. Future programme developers would benefit from closer attention to intervention development guidelines and a focus on supporting those with YOT2D to achieve behaviour change and diabetes self-management goals, ahead of change to biomedical outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

On request.

Code Availability

Not applicable.

Notes

  1. HbA1c or glycated haemoglobin is an indicator of an individual’s average blood glucose levels during the past 90–120 days; BMI: body mass index.

  2. The Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study was an extensive, multi-centre, multi-ethnic randomised trial assessing the efficacy of three treatment approaches (metformin, metformin plus rosiglitazone, and metformin plus lifestyle intervention) for 699 youth with T2D (234 in the lifestyle arm), aged 10–17 years.

References

  1. Chan JCN, et al. The Lancet Commission on diabetes: using data to transform diabetes care and patient lives. The Lancet. 2020;396(10267):2019–82.

    Article  CAS  Google Scholar 

  2. Lascar N, et al. Type 2 diabetes in adolescents and young adults. Lancet Diabetes Endocrinol. 2018;6(1):69–80.

    Article  PubMed  Google Scholar 

  3. Nadeau KJ, et al. Youth-onset type 2 diabetes consensus report: current status, challenges, and priorities. Diabetes Care. 2016;39(9):1635–42.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lascar N, et al. Phenotypic characteristics and risk factors in a multi-ethnic cohort of young adults with type 2 diabetes. Curr Med Res Opin. 2019;35(11):1893–900.

    Article  CAS  PubMed  Google Scholar 

  5. Bo, A., et al., Early-onset type 2 diabetes: age gradient in clinical and behavioural risk factors in 5115 persons with newly diagnosed type 2 diabetes—results from the DD2 study. Diabetes/Metabolism Research and Reviews, 2018. 34(3).

  6. Barrett T, et al. Rapid progression of type 2 diabetes and related complications in children and young people-A literature review. Pediatr Diabetes. 2020;21(2):158–72.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Nanayakkara N, et al. Impact of age at type 2 diabetes mellitus diagnosis on mortality and vascular complications: systematic review and meta-analyses. Diabetologia. 2021;64(2):275–87.

    Article  PubMed  Google Scholar 

  8. Magliano DJ, et al. Young-onset type 2 diabetes mellitus - implications for morbidity and mortality. Nat Rev Endocrinol. 2020;16(6):321–31.

    Article  PubMed  Google Scholar 

  9. Zhao L, et al. Type 2 diabetes mellitus in children and adolescents: early prevention and non-drug therapy. Journal of Diabetes Mellitus. 2017;7(3):21.

    Article  Google Scholar 

  10. Litterbach E, et al. I wish my health professionals understood that it’s not just all about your HbA1c!. Qualitative responses from the second Diabetes MILES – Australia (MILES-2) study. Diabetic Medicine. 2020;37(6):971–81.

    Article  CAS  PubMed  Google Scholar 

  11. Butler AM. Social determinants of health and racial/ethnic disparities in type 2 diabetes in youth. Curr DiabRep. 2017;17(8):60.

    Google Scholar 

  12. McGavock J, Wicklow B, Dart AB. Type 2 diabetes in youth is a disease of poverty. The Lancet. 2017;390(10105):1829.

    Article  Google Scholar 

  13. Lynch, J.L., et al., Country-specific prevalence and incidence of youth-onset type 2 diabetes: a narrative literature review. Annals of Nutrition and Metabolism, 2020.

  14. Dias J, et al. Diabetes risk and control in multi-ethnic US immigrant populations. Curr Diab Rep. 2020;20(12):73.

    Article  PubMed  Google Scholar 

  15. Othman N, et al. Factors affecting self-management among adolescents and youths with type 2 diabetes mellitus: a meta-synthesis. European Journal of Integrative Medicine. 2020;40:101228.

    Article  Google Scholar 

  16. Ke C, et al. Excess burden of mental illness and hospitalization in young-onset type 2 diabetes: a population-based cohort study. Ann Intern Med. 2019;170(3):145–54.

    Article  PubMed  Google Scholar 

  17. Browne JL, et al. Depression, anxiety and self-care behaviours of young adults with Type 2 diabetes: results from the International Diabetes Management and Impact for Long-term Empowerment and Success (MILES) Study. Diabet Med. 2015;32(1):133–40.

    Article  CAS  PubMed  Google Scholar 

  18. Bo A, et al. Prevalence and correlates of diabetes distress, perceived stress and depressive symptoms among adults with early-onset Type 2 diabetes: cross-sectional survey results from the Danish DD2 study. Diabet Med. 2020;37(10):1679–87.

    CAS  PubMed  Google Scholar 

  19. Archibald, M.M., et al., Youth perceptions and experiences of type 2 diabetes: protocol for a collaborative knowledge translation approach and qualitative study. J Adv Nurs, 2021.

  20. Hilliard ME, Powell PW, Anderson BJ. Evidence-based behavioral interventions to promote diabetes management in children, adolescents, and families. Am Psychol. 2016;71(7):590–601.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Arslanian S, et al. Evaluation and management of youth-onset type 2 diabetes: a position statement by the American Diabetes Association. Diabetes Care. 2018;41:2648–67.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Craig P, et al. Developing and evaluating complex interventions: the new Medical Research Council guidance. British Medical Journal. 2008;337:a1655.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bartholomew Eldredge LK, et al. Planning health promotion programs : an intervention mapping approach. 4th ed. San Francisco, CA: Jossey-Bass; 2016.

    Google Scholar 

  24. Abraham C, Denford S, et al. Design, implementation, and evaluation of behavior change interventions: a ten-task guide. In: Hagger MS, et al., editors. The handbook of behavior change. Cambridge: Cambridge University Press; 2020. p. 269–84.

    Chapter  Google Scholar 

  25. Michie S, Atkins L, West R. The behaviour change wheel: a guide to designing interventions. United Kingdom: Silverback Publishing; 2014.

    Google Scholar 

  26. O’Cathain A, et al. Guidance on how to develop complex interventions to improve health and healthcare. BMJ Open. 2019;9(8):e029954.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Medical Advisory Secretariat. Behavioural interventions for type 2 diabetes: an evidence-based analysis. Ont Health Technol Assess Ser. 2009;9(22):1–45.

    PubMed Central  Google Scholar 

  28. Wong SKW, et al. Effectiveness of self-management interventions in young adults with type 1 and 2 diabetes: a systematic review and meta-analysis. Diabetic medicine : a journal of the British Diabetic Association. 2020;37(2):229–41.

    Article  CAS  Google Scholar 

  29. Van Name M, Pediatric Diabetes Consortium. Transforming performance of clinical trials in pediatric type 2 diabetes: a Consortium model. Diabetes technology and therapeutics. 2020;22(4):330–6.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Zeitler P, et al. Clinical trials in youth-onset type 2 diabetes: needs, barriers, and options. Curr DiabRep. 2015;15(5):28.

    Google Scholar 

  31. Nambam B, et al. A cross-sectional view of the current state of treatment of youth with type 2 diabetes in the USA: enrollment data from the Pediatric Diabetes Consortium Type 2 Diabetes Registry. Pediatr Diabetes. 2017;18(3):222–9.

    Article  CAS  PubMed  Google Scholar 

  32. Jalaludin MY, et al. Recommendations for improving clinical trial design to facilitate the study of youth-onset type 2 diabetes. Clinical trials (London, England). 2020;17(1):87–98.

    Article  Google Scholar 

  33. World Health Organisation and Alliance for Health Policy and Systems Research. Rapid reviews to strengthen health policy and systems: a practical guide. 2017 [cited 2021 28 May]; Available from: https://www.who.int/alliance-hpsr/resources/publications/rapid-review-guide/en/.

  34. Faulkner MS, et al. Personalized exercise for adolescents with diabetes or obesity. Biol Res Nurs. 2014;16(1):46–54.

    Article  CAS  PubMed  Google Scholar 

  35. Huynh E, et al. Beating diabetes together: a mixed-methods analysis of a feasibility study of intensive lifestyle intervention for youth with type 2 diabetes. Can J Diabetes. 2015;39(6):484–90.

    Article  PubMed  Google Scholar 

  36. Kenney A, et al. The impact of a home-based diabetes prevention and management program on high-risk American Indian youth. Diabetes Educ. 2016;42(5):585–95.

    Article  PubMed  Google Scholar 

  37. Lake AJ, et al. Effect of a tailored leaflet to promote diabetic retinopathy screening among young adults with type 2 diabetes: a randomised controlled trial. BMC Ophthalmol. 2020;20(1):80.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Markowitz JT, et al. Text messaging intervention for teens and young adults with diabetes. J Diabetes Sci Technol. 2014;8(5):1029–34.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Otis M, et al. Testing usability and feasibility of a mobile educator tool for pediatric diabetes self-management: mixed methods pilot study. JMIR formative research. 2020;4(5):e16262.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Piven E, Duran R. Reduction of non-adherent behaviour in a Mexican-American adolescent with type 2 diabetes. Occup Ther Int. 2014;21(1):42–51.

    Article  PubMed  Google Scholar 

  41. Pyatak EA, et al. Occupational therapy intervention improves glycemic control and quality of life among young adults with diabetes: the Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) randomized controlled trial. Diabetes Care. 2018;41(4):696–704.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Samaan MC, et al. Design, implementation, and evaluation of a pediatric and adolescent type 2 diabetes management program at a tertiary pediatric center. J Multidiscip Healthc. 2014;7:321–31.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Sylvetsky AC, et al. Buddy study: partners for better health in adolescents with type 2 diabetes. World J Diabetes. 2015;6(18):1355–62.

    Article  PubMed  PubMed Central  Google Scholar 

  44. TODAY study group. A clinical trial to maintain glycemic control in youth with type 2 diabetes. N Engl J Med. 2012;366(24):2247–56.

    Article  PubMed Central  Google Scholar 

  45. Faulkner MS, Michaliszyn SF, Hepworth JT. A personalized approach to exercise promotion in adolescents with type 1 diabetes. Pediatr Diabetes. 2010;11(3):166–74.

    Article  PubMed  Google Scholar 

  46. Savoye M, et al. Anthropometric and psychosocial changes in obese adolescents enrolled in a Weight Management Program. J Am Diet Assoc. 2005;105(3):364–70.

    Article  PubMed  Google Scholar 

  47. Chambers RA, et al. A home-visiting diabetes prevention and management program for American Indian youth: the together on diabetes trial. Diabetes Educ. 2015;41(6):729–47.

    Article  PubMed  Google Scholar 

  48. Lake AJ, et al. A tailored intervention to promote uptake of retinal screening among young adults with type 2 diabetes - an intervention mapping approach. BMC Health Serv Res. 2018;18(1):396.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Pyatak EA, Carandang K, Davis S. Developing a manualized occupational therapy diabetes management intervention: Resilient, Empowered. Active Living With Diabetes OTJR (Thorofare N J). 2015;35(3):187–94.

    Google Scholar 

  50. TODAY Study Group. Design of a family-based lifestyle intervention for youth with type 2 diabetes: the TODAY study. Int J Obes (Lond). 2010;34(2):217–26.

    Article  Google Scholar 

  51. Bernier A, et al. New-onset diabetes educator to educate children and their caregivers about diabetes at the time of diagnosis: usability study. JMIR Diabetes. 2018;3(2):e10.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Troughton, J., et al., Developing an educational programme for children and teenagers (< 18 years) with type 2 diabetes: iCAN live well with diabetes. Diabet Med, 2019. 36(S1 (Abstracts of the Diabetes UK Professional Conference 2019, ACC Liverpool, Liverpool, 6–8 March 2019),): p. 1–185.

  53. Harrington DM, et al. Development of an interactive lifestyle programme for adolescents at risk of developing type 2 diabetes: PRE-STARt. Children. 2021;8(2):69.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Woodgate RL, Tennent P, Barriage S. Creating space for youth voice: implications of youth disclosure experiences for youth-centered research. Int J Qual Methods. 2020;19:1609406920958974.

    Article  Google Scholar 

  55. Hagger MS, Weed M. DEBATE: do interventions based on behavioral theory work in the real world? Int J Behav Nutr Phys Act. 2019;16(1):36.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Moore GF, et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ : British Medical Journal. 2015;350:h1258.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Afkinich JL, Blachman-Demner DR. Providing incentives to youth participants in research: a literature review. Journal of empirical research in human research ethics. 2020;15(3):202–15.

    Article  Google Scholar 

  58. Nguyen TT, et al. Challenging recruitment of youth with type 2 diabetes into clinical trials. J Adolesc Health. 2014;54(3):247–54.

    Article  PubMed  Google Scholar 

  59. Walders-Abramson N, et al. Benefits and barriers to participating in longitudinal research of youth-onset type 2 diabetes: results from the TODAY retention survey. Clinical trials (London, England). 2016;13(2):240–3.

    Article  Google Scholar 

  60. Amorrortu RP, et al. Recruitment of racial and ethnic minorities to clinical trials conducted within specialty clinics: an intervention mapping approach. Trials. 2018;19(1):115.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Berkowitz RI, et al. Adherence to a lifestyle program for youth with type 2 diabetes and its association with treatment outcome in the TODAY clinical trial. Pediatr Diabetes. 2018;19(2):191–8.

    Article  PubMed  Google Scholar 

  62. Nielsen MH, et al. To tell or not to tell: disclosure and self-management among adults with early-onset type 2 diabetes: a qualitative study. The Open Diabetes Journal. 2020;10(1):11–9.

    Article  Google Scholar 

  63. Moore, G., et al. Adaptation of interventions for implementation and/or re-evaluation in new contexts: the ADAPT guidance (v1.0). 2020 [cited 2021 29 April]; Available from: https://decipher.uk.net/wp-content/uploads/2020/11/ADAPT-guidance-for-website-upload-v1.0-12-10-20.pdf.

  64. McSharry J, et al. Behaviour change in diabetes: behavioural science advancements to support the use of theory. Diabet Med. 2020;37(3):455–63.

    CAS  PubMed  Google Scholar 

  65. Bowen S, et al. Engaging teenagers productively in service design. International Journal of Child-Computer Interaction. 2013;1(3):71–81.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Thabrew H, et al. Co-design of eHealth interventions with children and young people. Front Psych. 2018;9:481–481.

    Article  Google Scholar 

  67. National Insititute for Health and Care Excellence. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. 2015 [cited 2021 29 April]; Available from: www.nice.org.uk/guidance/ng18.

  68. Cruz P, Granados A. Type 2 diabetes in Latino youth: a clinical update and current challenges. Curr Probl Pediatr Adolesc Health Care. 2019;49(1):16–22.

    Article  PubMed  Google Scholar 

  69. Curran JA, Haynes A, Davis EA. Clinical characteristics of Western Australian children diagnosed with type 2 diabetes before 10 years of age. Med J Aust. 2020;212(2):95-95 e1.

    Article  PubMed  Google Scholar 

  70. Boutron I, et al. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med. 2008;148:17.

    Article  Google Scholar 

  71. Fok CC, Henry D, Allen J. Maybe small is too small a term: introduction to advancing small sample prevention science. Prevention Science. 2015;16 (Special section)(7):943–9.

    Article  Google Scholar 

  72. Rigaux C, Sébastien B. Evaluation of non-linear-mixed-effect modeling to reduce the sample sizes of pediatric trials in type 2 diabetes mellitus. J Pharmacokinet Pharmacodyn. 2020;47(1):59–67.

    Article  CAS  PubMed  Google Scholar 

  73. Lancaster GA, Thabane L. Guidelines for reporting non-randomised pilot and feasibility studies. Pilot Feasibility Stud. 2019;5:114.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Thabane L, Lancaster G. A guide to the reporting of protocols of pilot and feasibility trials. Pilot Feasibility Stud. 2019;5:37.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Czajkowski SM, et al. From ideas to efficacy: the ORBIT model for developing behavioral treatments for chronic diseases. Health Psychol. 2015;34(10):971–82.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Kriska A, et al. Impact of lifestyle behavior change on glycemic control in youth with type 2 diabetes. Pediatr Diabetes. 2018;19(1):36–44.

    Article  CAS  PubMed  Google Scholar 

  77. Huynh E. The mountain of health: the perceptions and perceived expectations of youth living with type 2 diabetes in Winnipeg, Manitoba, Canada, through a grounded theory study. Can J Diabetes. 2018;42(4):344–9.

    Article  PubMed  Google Scholar 

  78. Skovlund SE, et al. Can the routine use of patient-reported outcome measures improve the delivery of person-centered diabetes care? A review of recent developments and a case study. Curr DiabRep. 2019;19(9):84.

    Google Scholar 

  79. de Wit M, et al. Using person-reported outcomes (PROs) to motivate young people with diabetes. Curr DiabRep. 2020;20(7):23.

    Google Scholar 

  80. Byrne, M., et al., A core outcomes set for clinical trials of interventions for young adults with type 1 diabetes: an international, multi-perspective Delphi consensus study. Trials, 2017. 18(1).

  81. Sherratt FC, et al. Ensuring young voices are heard in core outcome set development: international workshops with 70 children and young people. Research Involvement and Engagement. 2020;6(1):19.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Harman NL, et al. Selecting Core Outcomes for Randomised Effectiveness trials In Type 2 diabetes (SCORE-IT): a patient and healthcare professional consensus on a core outcome set for type 2 diabetes. BMJ Open Diabetes Research & Care. 2019;7(1):e000700.

    Article  Google Scholar 

  83. Association for size diversity and health. Healthy at every size. [cited 2021 19 April]; Available from: https://asdah.org/.

  84. Ulian MD, et al. Effects of health at every size® interventions on health-related outcomes of people with overweight and obesity: a systematic review. Obes Rev. 2018;19(12):1659–66.

    Article  CAS  PubMed  Google Scholar 

  85. Mead E, et al. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Cochrane Database Syst Rev. 2017;6:CD012651.

    PubMed  Google Scholar 

  86. Amed, S., The future of treating youth-onset type 2 diabetes: focusing upstream and extending our influence into community environments. Curr Diab Rep, 2015. 15(3).

Download references

Acknowledgements

We thank our post-doctoral mentors (Prof Jane Speight, Prof Helle Terkildsen Maindal, Prof Melanie Davies) for their support and manuscript review.

Author information

Authors and Affiliations

  1. School of Psychology, Deakin University, Geelong, VIC, 3220, Australia

    Amelia J. Lake

  2. The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne VIC, 3000, Australia

    Amelia J. Lake

  3. Department of Public Health, Aarhus University, Aarhus, Denmark

    Anne Bo

  4. Diabetes Research Centre, Leicester Diabetes Centre, University of Leicester, Leicester, UK

    Michelle Hadjiconstantinou

Authors
  1. Amelia J. Lake
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anne Bo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michelle Hadjiconstantinou
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the idea for the article, conception, and format. Literature search and data synthesis were performed by Amelia Lake. Anne Bo and Michelle Hadjiconstantinou independently validated data extraction and synthesis. All authors contributed to the original manuscript drafts and commented on subsequent versions. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Amelia J. Lake.

Ethics declarations

Ethics Approval

Not applicable.

Consent to Participate

Not applicable.

Consent for Publication

Not applicable.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Psychosocial Aspects

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lake, A.J., Bo, A. & Hadjiconstantinou, M. Developing and Evaluating Behaviour Change Interventions for People with Younger-Onset Type 2 Diabetes: Lessons and Recommendations from Existing Programmes. Curr Diab Rep 21, 59 (2021). https://doi.org/10.1007/s11892-021-01432-1

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11892-021-01432-1

Keywords

Search

Navigation