Purpose of Review
Diabetes self-management and diabetes distress are complex processes implicated in glycemic control and other health outcomes for youth with type 1 diabetes. Growing integration of medical and behavioral care provides opportunities for brief psychosocial interventions during routine diabetes care. This review focuses on interventions for self-management and diabetes distress that can be delivered alongside usual medical care or via a single-patient encounter.
Recent research underscores the potential of brief interventions delivered by both medical providers and integrated behavioral health professionals, but little is known regarding the comparative effectiveness of different interventions or the factors that impact dissemination and implementation.
This article asserts that brevity is critical to maximizing the reach, scalability, and impact of psychosocial interventions for youth with type 1 diabetes. The authors review existing evidence for brief interventions, describe several untested clinical strategies, and make recommendations for accelerating the translational study of brief interventions.
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Foster NC, Beck RW, Miller KM, Clements MA, Rickels MR, DiMeglio LA, et al. State of type 1 diabetes management and outcomes from the T1D Exchange in 2016-2018. Diabetes Technol Ther. 2019;21(2):66–72. https://doi.org/10.1089/dia.2018.0384.
Hood KK, Peterson CM, Rohan JM, Drotar D. Association between adherence and glycemic control in pediatric type 1 diabetes: a meta-analysis. Pediatrics. 2009;124(6):e1171–e9.
Iturralde E, Rausch JR, Weissberg-Benchell J, Hood KK. Diabetes-related emotional distress over time. Pediatrics. 2019;143(6):e20183011. https://doi.org/10.1542/peds.2018-3011.
Hagger V, Hendrieckx C, Cameron F, Pouwer F, Skinner TC, Speight J. Diabetes distress is more strongly associated with HbA1c than depressive symptoms in adolescents with type 1 diabetes: results from Diabetes MILES Youth—Australia. Pediatr Diabetes. 2018;19(4):840–7.
Hood KK, Rohan JM, Peterson CM, Drotar D. Interventions with adherence-promoting components in pediatric type 1 diabetes: meta-analysis of their impact on glycemic control. Diabetes Care. 2010;33(7):1658–64.
Graves MM, Roberts MC, Rapoff M, Boyer A. The efficacy of adherence interventions for chronically ill children: a meta-analytic review. J Pediatr Psychol. 2010;35(4):368–82. https://doi.org/10.1093/jpepsy/jsp072.
Pai AL, McGrady M. Systematic review and meta-analysis of psychological interventions to promote treatment adherence in children, adolescents, and young adults with chronic illness. J Pediatr Psychol. 2014;39(8):918–31. https://doi.org/10.1093/jpepsy/jsu038.
Rothwell PM. External validity of randomised controlled trials:“to whom do the results of this trial apply?”. Lancet. 2005;365(9453):82–93.
Riley WT. Behavioral and social sciences at the National Institutes of Health: adoption of research findings in health research and practice as a scientific priority. Transl Behav Med. 2017;7(2):380–4.
Ghate D. From programs to systems: deploying implementation science and practice for sustained real world effectiveness in services for children and families. J Clin Child Adolesc Psychol. 2016;45(6):812–26. https://doi.org/10.1080/15374416.2015.1077449.
Atkins MS, Rusch D, Mehta TG, Lakind D. Future directions for dissemination and implementation science: aligning ecological theory and public health to close the research to practice gap. J Clin Child Adolesc Psychol. 2016;45(2):215–26. https://doi.org/10.1080/15374416.2015.1050724.
• 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. https://doi.org/10.1037/a0040359 This review outlines contemporary behavioral interventions, not limited to brief procedures, that promote optimal diabetes self-management in youth with T1D, summarizing the evidence base for established diabetes skills training programs, family interventions, and multi-systemic interventions.
Datye KA, Moore DJ, Russell WE, Jaser SS. A review of adolescent adherence in type 1 diabetes and the untapped potential of diabetes providers to improve outcomes. Curr Diab Rep. 2015;15(8):51. https://doi.org/10.1007/s11892-015-0621-6.
Guttmann-Bauman I, Thornton P, Adhikari S, Reifschneider K, Wood M, Hamby T, et al. Pediatric endocrine society survey of diabetes practices in the United States: what is the current state? Pediatr Diabetes. 2018;19(5):859–65.
Rose M, Aronow L, Breen S, Tully C, Hilliard ME, Butler AM, et al. Considering culture: a review of pediatric behavioral intervention research in type 1 diabetes. Curr Diab Rep. 2018;18(4):16. https://doi.org/10.1007/s11892-018-0987-3.
Baxter J, Vehik K, Johnson SB, Lernmark B, Roth R, Simell T, et al. Differences in recruitment and early retention among ethnic minority participants in a large pediatric cohort: the TEDDY Study. Contemp Clin Trials. 2012;33(4):633–40.
Semenkovich K, Berlin KS, Ankney RL, Klages KL, Keenan ME, Rybak TM, et al. Predictors of diabetic ketoacidosis hospitalizations and hemoglobin A1c among youth with Type 1 diabetes. Health Psychol. 2019;38(7):577–85. https://doi.org/10.1037/hea0000719.
Strauss K, MacLean C, Troy A, Littenberg B. Driving distance as a barrier to glycemic control in diabetes. J Gen Intern Med. 2006;21(4):378.
Lopez-Class M, Jurkowski J. The limits of self-management: community and health care system barriers among Latinos with diabetes. J Hum Behav Soc Environ. 2010;20(6):808–26.
Karlson CW, Rapoff MA. Attrition in randomized controlled trials for pediatric chronic conditions. J Pediatr Psychol. 2009;34(7):782–93. https://doi.org/10.1093/jpepsy/jsn122.
Schwartz DD, Cline VD, Axelrad ME, Anderson BJ. Feasibility, acceptability, and predictive validity of a psychosocial screening program for children and youth newly diagnosed with type 1 diabetes. Diabetes Care. 2011;34(2):326–31. https://doi.org/10.2337/dc10-1553.
Markowitz JT, Volkening LK, Laffel LM. Care utilization in a pediatric diabetes clinic: cancellations, parental attendance, and mental health appointments. J Pediatr. 2014;164(6):1384–9.
Chiang JL, Kirkman MS, Laffel LM, Peters AL. Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes Care. 2014;37(7):2034–54.
Murphy HR, Rayman G, Skinner TC. Psycho-educational interventions for children and young people with Type 1 diabetes. Diabet Med. 2006;23(9):935–43. https://doi.org/10.1111/j.1464-5491.2006.01816.x.
Beck J, Greenwood DA, Blanton L, Bollinger ST, Butcher MK, Condon JE, et al. 2017 National standards for diabetes self-management education and support. Diabetes Educ. 2018;45(1):34–49. https://doi.org/10.1177/0145721718820941.
Phelan H, Lange K, Cengiz E, Gallego P, Majaliwa E, Pelicand J, et al. ISPAD Clinical Practice Consensus Guidelines 2018: diabetes education in children and adolescents. Pediatr Diabetes. 2018;19(S27):75–83. https://doi.org/10.1111/pedi.12762.
Hill-Briggs F, Gemmell L. Problem solving in diabetes self-management and control. Diabetes Educ. 2007;33(6):1032–50. https://doi.org/10.1177/0145721707308412.
Hampson SE, Skinner TC, Hart J, Storey L, Gage H, Foxcroft D, et al. Effects of educational and psychosocial interventions for adolescents with diabetes mellitus: a systematic review. Health Technol Assess. 2001;5(10):1–79.
Funnell MM, Tang TS, Anderson RM. From DSME to DSMS: Developing empowerment-based diabetes self-management support. Diabetes Spectr. 2007;20(4):221–6. https://doi.org/10.2337/diaspect.20.4.221.
Channon SJ, Huws-Thomas MV, Rollnick S, Hood K, Cannings-John RL, Rogers C, et al. A multicenter randomized controlled trial of motivational interviewing in teenagers with diabetes. Diabetes Care. 2007;30(6):1390–5. https://doi.org/10.2337/dc06-2260.
Stanger C, Ryan SR, Delhey LM, Thrailkill K, Li Z, Li Z, et al. A multicomponent motivational intervention to improve adherence among adolescents with poorly controlled type 1 diabetes: a pilot study. J Pediatr Psychol. 2013;38(6):629–37.
Gayes LA, Steele RG. A meta-analysis of motivational interviewing interventions for pediatric health behavior change. J Consult Clin Psychol. 2014;82(3):521–35. https://doi.org/10.1037/a0035917.
Wang Y-C, Stewart SM, Mackenzie M, Nakonezny PA, Edwards D, White PC. A randomized controlled trial comparing motivational interviewing in education to structured diabetes education in teens with type 1 diabetes. Diabetes Care. 2010;33(8):1741–3. https://doi.org/10.2337/dc10-0019.
Powell PW, Hilliard ME, Anderson BJ. Motivational interviewing to promote adherence behaviors in pediatric type 1 diabetes. Curr Diab Rep. 2014;14(10):531. https://doi.org/10.1007/s11892-014-0531-z.
• Hilliard ME, De Wit M, Wasserman RM, Butler AM, Evans M, Weissberg-Benchell J, et al. Screening and support for emotional burdens of youth with type 1 diabetes: strategies for diabetes care providers. Pediatr Diabetes. 2018;19(3):534–43. https://doi.org/10.1111/pedi.12575 This article reviews recommended practical strategies for providers to screen and support beahavioral issues as part of routine care.
Robling M, McNamara R, Bennert K, Butler CC, Channon S, Cohen D, et al. The effect of the Talking Diabetes consulting skills intervention on glycaemic control and quality of life in children with type 1 diabetes: cluster randomised controlled trial (DEPICTED study). BMJ. 2012;344:e2359. https://doi.org/10.1136/bmj.e2359.
Söderlund LL, Madson MB, Rubak S, Nilsen P. A systematic review of motivational interviewing training for general health care practitioners. Patient Educ Couns. 2011;84(1):16–26.
Wyatt KD, List B, Brinkman WB, Prutsky Lopez G, Asi N, Erwin P, et al. Shared decision making in pediatrics: a systematic review and meta-analysis. Acad Pediatr. 2015;15(6):573–83. https://doi.org/10.1016/j.acap.2015.03.011.
Miller VA, Jawad AF. Relationship of youth involvement in diabetes-related decisions to treatment adherence. J Clin Psychol Med Settings. 2014;21(2):183–9. https://doi.org/10.1007/s10880-014-9388-1.
Wysocki T, Hirschfeld F, Miller L, Izenberg N, Dowshen SA, Taylor A et al. Consideration of insulin pumps or continuous glucose monitors by adolescents with type 1 diabetes and their parents: stakeholder engagement in the design of web-based decision aids. 2016;42(4):395–407. doi:https://doi.org/10.1177/0145721716647492.
Husted GR, Thorsteinsson B, Esbensen BA, Gluud C, Winkel P, Hommel E, et al. Effect of guided self-determination youth intervention integrated into outpatient visits versus treatment as usual on glycemic control and life skills: a randomized clinical trial in adolescents with type 1 diabetes. Trials. 2014;15(1):321.
•• Hilliard ME, Eshtehardi SS, Minard CG, Wheat S, Gunn S, Sanders C, et al. Featured article: Strengths-based, clinic-integrated nonrandomized pilot intervention to promote type 1 diabetes adherence and well-being. J Pediatr Psychol. 2018;44(1):5–15 This study provides an example of a brief (5–10 min) clinic-integrated, provider-led intervention designed specifically for youth with T1D. Preliminary results suggest high accepability by providers and families, as well as improvements to adolescent self-management behaviors and diabetes distress.
De Wit M. Delemarre-van de Waal HA, Bokma JA, Haasnoot K, Houdijk MC, Gemke RJ et al. Monitoring and discussing health-related quality of life in adolescents with type 1 diabetes improve psychosocial well-being: a randomized controlled trial. Diabetes Care. 2008;31(8):1521–6.
De Wit M. Delemarre-van de Waal HA, Bokma JA, Haasnoot K, Houdijk MC, Gemke RJ et al. Follow-up results on monitoring and discussing health-related quality of life in adolescent diabetes care: benefits do not sustain in routine practice. Pediatr Diabetes. 2010;11(3):175–81.
Monaghan M, Clary L, Mehta P, Stern A, Sharkey C, Cogen FR, et al. Checking in: a pilot of a physician-delivered intervention to increase parent–adolescent communication about blood glucose monitoring. Clin Pediatr. 2015;54(14):1346–53.
Wu YP, Pai AL. Health care provider-delivered adherence promotion interventions: a meta-analysis. Pediatrics. 2014;133(6):e1698–707. https://doi.org/10.1542/peds.2013-3639.
Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47(8):826–34. https://doi.org/10.1097/MLR.0b013e31819a5acc.
Nansel TR, Thomas DM, Liu A. Efficacy of a behavioral intervention for pediatric type 1 diabetes across income. Am J Prev Med. 2015;49(6):930–4. https://doi.org/10.1016/j.amepre.2015.05.006.
Nansel TR, Iannotti RJ, Liu A. Clinic-integrated behavioral intervention for families of youth with type 1 diabetes: randomized clinical trial. Pediatrics. 2012;129(4):e866–73. https://doi.org/10.1542/peds.2011-2858.
Laffel LM, Vangsness L, Connell A, Goebel-Fabbri A, Butler D, Anderson BJ. Impact of ambulatory, family-focused teamwork intervention on glycemic control in youth with type 1 diabetes. J Pediatr. 2003;142(4):409–16. https://doi.org/10.1067/mpd.2003.138.
Holmes CS, Chen R, Mackey E, Grey M, Streisand R. Randomized clinical trial of clinic-integrated, low-intensity treatment to prevent deterioration of disease care in adolescents with type 1 diabetes. Diabetes Care. 2014;37(6):1535–43. https://doi.org/10.2337/dc13-1053.
Carney RM, Schecheter K, Davis T. Improving adherence to blood glucose testing in insulin-dependent diabetic children. Behav Ther. 1983;14(2):247–54.
Petry NM, Rash CJ, Byrne S, Ashraf S, White WB. Financial reinforcers for improving medication adherence: findings from a meta-analysis. Am J Med. 2012;125(9):888–96.
Stoeckel M, Duke D. Diabetes and behavioral learning principles: often neglected yet well-known and empirically validated means of optimizing diabetes care behavior. Curr Diab Rep. 2015;15(7):39. https://doi.org/10.1007/s11892-015-0615-4.
Wagner JA, Petry NM, Weyman K, Tichy E, Cengiz E, Zajac K, et al. Glucose management for rewards: a randomized trial to improve glucose monitoring and associated self-management behaviors in adolescents with type 1 diabetes. Pediatr Diabetes. 2019.
Wong CA, Miller VA, Murphy K, Small D, Ford CA, Willi SM, et al. Effect of financial incentives on glucose monitoring adherence and glycemic control among adolescents and young adults with type 1 diabetes: a randomized clinical trial. JAMA Pediatr. 2017;171(12):1176–83.
Maranda L, Lau M, Stewart SM, Gupta OT. A novel behavioral intervention in adolescents with type 1 diabetes mellitus improves glycemic control: preliminary results from a pilot randomized control trial. Diabetes Educ. 2015;41(2):224–30. https://doi.org/10.1177/0145721714567235.
Unützer J, Harbin H, Schoenbaum M, Druss B. The collaborative care model: an approach for integrating physical and mental health care in Medicaid health homes. HEALTH HOME, Information Resource Center 2013:1–13.
Bitsko MJ, Bean MK, Bart S, Foster RH, Thacker L, Francis GL. Psychological treatment improves hemoglobin A1c outcomes in adolescents with type 1 diabetes mellitus. J Clin Psychol Med Settings. 2013;20(3):333–42. https://doi.org/10.1007/s10880-012-9350-z.
Kichler JC, Harris MA, Weissberg-Benchell J. Contemporary roles of the pediatric psychologist in diabetes care. Curr Diabetes Rep. 2015;11(4):210–21.
Harris MA, Hood KK, Weissberg-Benchell J. Teens with diabetes: a clinician’s guide. Alexandria: American Diabetes Association; 2014.
Ingerski LM, Anderson BJ, Dolan LM, Hood KK. Blood glucose monitoring and glycemic control in adolescence: contribution of diabetes-specific responsibility and family conflict. J Adolesc Health. 2010;47(2):191–7.
Hilliard ME, Wu YP, Rausch J, Dolan LM, Hood KK. Predictors of deteriorations in diabetes management and control in adolescents with type 1 diabetes. J Adolesc Health. 2013;52(1):28–34. https://doi.org/10.1016/j.jadohealth.2012.05.009.
Williams LB, Laffel LM, Hood KK. Diabetes-specific family conflict and psychological distress in paediatric type 1 diabetes. Diabet Med. 2009;26(9):908–14. https://doi.org/10.1111/j.1464-5491.2009.02794.x.
Weissberg-Benchell J. Personal communcation. November 15, 2019.
Grey M, Berry D. Coping skills training and problem solving in diabetes. Curr Diab Rep. 2004;4(2):126–31.
Grey M, Jaser SS, Whittemore R, Jeon S, Lindemann E. Coping skills training for parents of children with type 1 diabetes: 12-month outcomes. Nurs Res. 2011;60(3):173.
Iturralde E, Weissberg-Benchell J, Hood KK. Avoidant coping and diabetes-related distress: pathways to adolescents’ type 1 diabetes outcomes. Health Psychol. 2017;36(3):236–44. https://doi.org/10.1037/hea0000445.
Kamody RC, Berlin KS, Rybak TM, Klages KL, Banks GG, Ali JS, et al. Psychological flexibility among youth with type 1 diabetes: relating patterns of acceptance, adherence, and stress to adaptation. Behav Med. 2018;44(4):271–9.
Gillanders DT, Barker E. Development and initial validation of a short form of the diabetes acceptance and Action Scale: The DAAS-Revised (DAAS-R). J Contextual Behav Sci. 2019;14:20–8.
Graham CD, Gouick J, Krahe C, Gillanders D. A systematic review of the use of Acceptance and Commitment Therapy (ACT) in chronic disease and long-term conditions. Clin Psychol Rev. 2016;46:46–58.
Hayes SC, Strosahl K, Wilson KG. Acceptance and Commitment Therapy: an experiential approach to behavior change. New York: Guilford; 1999.
Campbell-Sills L, Barlow DH, Brown TA, Hofmann SG. Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders. Behav Res Ther. 2006;44(9):1251–63. https://doi.org/10.1016/j.brat.2005.10.001.
Eifert GH, Heffner M. The effects of acceptance versus control contexts on avoidance of panic-related symptoms. J Behav Ther Exp Psychiatry. 2003;34(3–4):293–312. https://doi.org/10.1016/j.jbtep.2003.11.001.
• Barreto M, Tran TA, Gaynor ST. A single-session of Acceptance and Commitment Therapy for health-related behavior change: an open trial with a nonconcurrent matched comparison group. J Contextual Behav Sci. 2019;13:17–26. https://doi.org/10.1016/j.jcbs.2019.06.003 This study provides an example of a one-session intervention protocol using Acceptance Commitment Therapy to target health behavior change.
Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46(1):81–95. https://doi.org/10.1007/s12160-013-9486-6.
Fisher L, Gonzalez J, Polonsky W. The confusing tale of depression and distress in patients with diabetes: a call for greater clarity and precision. Diabet Med. 2014;31(7):764–72.
Fisher L, Skaff MM, Mullan JT, Arean P, Mohr D, Masharani U, et al. Clinical depression versus distress among patients with type 2 diabetes. Not just a question of semantics. Diabetes Care. 2007;30(3):542–8. https://doi.org/10.2337/dc06-1614.
Young-Hyman D, de Groot M, Hill-Briggs F, Gonzalez JS, Hood K, Peyrot M. Psychosocial care for people with diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(12):2126–40. https://doi.org/10.2337/dc16-2053.
Mulvaney SA, Anders S, Smith AK, Pittel EJ, Johnson KB. A pilot test of a tailored mobile and web-based diabetes messaging system for adolescents. J Telemed Telecare. 2012;18(2):115–8. https://doi.org/10.1258/jtt.2011.111006.
Franklin VL, Waller A, Pagliari C, Greene SA. A randomized controlled trial of Sweet Talk, a text-messaging system to support young people with diabetes. Diabet Med. 2006;23(12):1332–8. https://doi.org/10.1111/j.1464-5491.2006.01989.x.
Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322–7. https://doi.org/10.2105/ajph.89.9.1322.
Green LW. Making research relevant: if it is an evidence-based practice, where’s the practice-based evidence? Fam Pract. 2008;25(suppl_1):i20–i4.
Yarbro JL, Mehlenbeck R. Financial analysis of behavioral health services in a pediatric endocrinology clinic. J Pediatr Psychol. 2016;41(8):879–87. https://doi.org/10.1093/jpepsy/jsv109.
Raiff BR, Dallery J. Internet-based contingency management to improve adherence with blood glucose testing recommendations for teens with type 1 diabetes. J Appl Behav Anal. 2010;43(3):487–91.
Kumar VS, Wentzell KJ, Mikkelsen T, Pentland A, Laffel LM. The DAILY (Daily Automated Intensive Log for Youth) trial: a wireless, portable system to improve adherence and glycemic control in youth with diabetes. Diabetes Technol Ther. 2004;6(4):445–53. https://doi.org/10.1089/1520915041705893.
Duke DC, Barry S, Wagner DV, Speight J, Choudhary P, Harris MA. Distal technologies and type 1 diabetes management. Lancet Diabetes Endocrinol. 2018;6(2):143–56.
Plante WA, Lobato DJ. Psychosocial group interventions for children and adolescents with type 1 diabetes: the state of the literature. Child Health Care. 2008;37(2):93–111.
Weissberg-Benchell J, Vesco AT, Rychlik K. Diabetes camp still matters: relationships with diabetes-specific distress, strengths, and self-care skills. Pediatr Diabetes. 2019;20(3):353–60. https://doi.org/10.1111/pedi.12836.
Litchman ML, Walker HR, Ng AH, Wawrzynski SE, Oser SM, Greenwood DA, et al. State of the science: a scoping review and gap analysis of diabetes online communities. J Diabetes Sci Technol. 2019;13(3):466–92.
Markowitz JT, Laffel LM. Transitions in care: support group for young adults with type 1 diabetes. Diabet Med. 2012;29(4):522–5. https://doi.org/10.1111/j.1464-5491.2011.03537.x.
Chorpita BF, Daleiden EL, Weisz JR. Identifying and selecting the common elements of evidence based interventions: a distillation and matching model. Ment Health Serv Res. 2005;7(1):5–20.
Jacobson NS, Dobson KS, Truax PA, Addis ME, Koerner K, Gollan JK, et al. A component analysis of cognitive–behavioral treatment for depression. J Consult Clin Psychol. 1996;64(2):295–304. https://doi.org/10.1037//0022-006x.64.2.295.
Collins LM. Optimization of Behavioral, Biobehavioral, and Biomedical Interventions. Statistics for Social and Behavioral Sciences. Cham: Springer; 2018.
Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012;50(3):217–26. https://doi.org/10.1097/MLR.0b013e3182408812.
• Price J, Beidas RS, Wolk CB, Genuario K, Kazak AE. Implementation science in pediatric psychology: the example of type 1 diabetes. J Pediatr Psychol. 2019;44(9):1068–73. https://doi.org/10.1093/jpepsy/jsz030 This article details how implementation science frameworks can be used to guide research to advance the practice of pediatric diabetes care.
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):50.
Bismuth E, Laffel L. Can we prevent diabetic ketoacidosis in children? Pediatr Diabetes. 2007;8:24–33.
This manuscript was supported by grant number K12 HS022981 from the Agency for Healthcare Research and Quality (for ARR).
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Barry-Menkhaus, S.A., Wagner, D.V. & Riley, A.R. Small Interventions for Big Change: Brief Strategies for Distress and Self-Management Amongst Youth with Type 1 Diabetes. Curr Diab Rep 20, 3 (2020). https://doi.org/10.1007/s11892-020-1290-7
- Type 1 diabetes
- Diabetes distress
- Brief intervention