Self-Management Group Education to Reduce Fear of Hypoglycemia as a Barrier to Physical Activity in Adults Living With Type 1 Diabetes: A Pilot Randomized Controlled Trial

Marian C. Brennan; Matthew A. Albrecht; Janie A. Brown; Gavin D. Leslie; Nikos Ntoumanis

doi:10.1016/j.jcjd.2021.01.001

Self-Management Group Education to Reduce Fear of Hypoglycemia as a Barrier to Physical Activity in Adults Living With Type 1 Diabetes: A Pilot Randomized Controlled Trial

Marian C. Brennan^*
, Matthew A. Albrecht
, Janie A. Brown
, Gavin D. Leslie
, Nikos Ntoumanis

^*Corresponding author for this work

Curtin University
St John of God Midland Public and Private Hospital

Research output: Contribution to journal › Journal article › Research › peer-review

Abstract

Objectives: The aim of this study was to evaluate the feasibility, acceptability and preliminary efficacy of a theory-driven group education intervention designed to reduce fear of hypoglycemia (FoH) as a barrier to physical activity (PA) in adults with type 1 diabetes (T1D). Methods: This study was a single-blinded, pilot randomized controlled trial of adults aged 18 to 65 years and living with T1D in Western Australia. Participants were randomized (1:1) to standard care or intervention with self-management education. Primary outcomes were feasibility and acceptability of the study procedures, and change to barriers to PA and FoH. Secondary outcomes were change to attitudes and intentions toward PA, self-reported participation in PA, self-efficacy, diabetes distress and well-being. To calculate effect sizes, we used a Bayesian comparison of the between-group difference scores (i.e. [score_t2 − score_t1]_TREATMENT vs [score_t2 − score_t1]_CONTROL). Results: We randomized 117 participants with T1D, 86 (74%) of whom provided baseline data and attended initial workshops. Of these participants, 81% attended the booster workshop 4 weeks later. They were 45±12 years of age, reported high levels of activity and had been living with T1D for 20±14 years. Small-to-moderate effect sizes [ESs] in favour of the intervention were observed at 12 weeks for overall barriers to PA (ES, −0.38; highest density interval, −0.92 to 0.17), self-efficacy for blood glucose management after PA (ES, 0.45; highest density interval, 0 to 0.91), diabetes distress (ES, −0.29; highest density interval, −0.77 to 0.15) and well-being (ES, 0.36; highest density interval, −0.12 to 0.8). Conclusions: Quantitative findings indicate study procedures were acceptable to participants and feasible to deliver. A future definitive trial is justified to replicate preliminary efficacy and to determine the utility of the intervention for improving PA participation.

Original language	English
Journal	Canadian Journal of Diabetes
Volume	45
Issue number	7
Pages (from-to)	619-628
ISSN	1499-2671
DOIs	https://doi.org/10.1016/j.jcjd.2021.01.001
Publication status	Published - Oct 2021
Externally published	Yes

Bibliographical note

Funding Information:
The authors thank the research participants and steering group members for volunteering their time and providing meaningful contributions throughout the project. We also thank Diabetes Western Australia for providing in-kind support to the project. This research article contributes toward a Doctor of Philosophy degree pursued by M.C.B.

Funding Information:
M.B. is an employee of Diabetes Western Australia, but the organization had no influence on the interpretation or reporting of results beyond consumer group participation. M.B. is the recipient of a research fellowship from the Australian Diabetes Educator Association–Diabetes Research Foundation, which has provided a researcher stipend to support Doctor of Philosophy Studies.

Funding

The authors thank the research participants and steering group members for volunteering their time and providing meaningful contributions throughout the project. We also thank Diabetes Western Australia for providing in-kind support to the project. This research article contributes toward a Doctor of Philosophy degree pursued by M.C.B. M.B. is an employee of Diabetes Western Australia, but the organization had no influence on the interpretation or reporting of results beyond consumer group participation. M.B. is the recipient of a research fellowship from the Australian Diabetes Educator Association–Diabetes Research Foundation, which has provided a researcher stipend to support Doctor of Philosophy Studies.

Keywords

adults
diabetes mellitus
exercise
fear of hypoglycemia
health education
self-management
type 1

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@article{97edd3167a1247f7a4d40acd7bf663a5,

title = "Self-Management Group Education to Reduce Fear of Hypoglycemia as a Barrier to Physical Activity in Adults Living With Type 1 Diabetes: A Pilot Randomized Controlled Trial",

abstract = "Objectives: The aim of this study was to evaluate the feasibility, acceptability and preliminary efficacy of a theory-driven group education intervention designed to reduce fear of hypoglycemia (FoH) as a barrier to physical activity (PA) in adults with type 1 diabetes (T1D). Methods: This study was a single-blinded, pilot randomized controlled trial of adults aged 18 to 65 years and living with T1D in Western Australia. Participants were randomized (1:1) to standard care or intervention with self-management education. Primary outcomes were feasibility and acceptability of the study procedures, and change to barriers to PA and FoH. Secondary outcomes were change to attitudes and intentions toward PA, self-reported participation in PA, self-efficacy, diabetes distress and well-being. To calculate effect sizes, we used a Bayesian comparison of the between-group difference scores (i.e. [scoret2 − scoret1]TREATMENT vs [scoret2 − scoret1]CONTROL). Results: We randomized 117 participants with T1D, 86 (74\%) of whom provided baseline data and attended initial workshops. Of these participants, 81\% attended the booster workshop 4 weeks later. They were 45±12 years of age, reported high levels of activity and had been living with T1D for 20±14 years. Small-to-moderate effect sizes [ESs] in favour of the intervention were observed at 12 weeks for overall barriers to PA (ES, −0.38; highest density interval, −0.92 to 0.17), self-efficacy for blood glucose management after PA (ES, 0.45; highest density interval, 0 to 0.91), diabetes distress (ES, −0.29; highest density interval, −0.77 to 0.15) and well-being (ES, 0.36; highest density interval, −0.12 to 0.8). Conclusions: Quantitative findings indicate study procedures were acceptable to participants and feasible to deliver. A future definitive trial is justified to replicate preliminary efficacy and to determine the utility of the intervention for improving PA participation.",

keywords = "adults, diabetes mellitus, exercise, fear of hypoglycemia, health education, self-management, type 1",

author = "Brennan, \{Marian C.\} and Albrecht, \{Matthew A.\} and Brown, \{Janie A.\} and Leslie, \{Gavin D.\} and Nikos Ntoumanis",

note = "Funding Information: The authors thank the research participants and steering group members for volunteering their time and providing meaningful contributions throughout the project. We also thank Diabetes Western Australia for providing in-kind support to the project. This research article contributes toward a Doctor of Philosophy degree pursued by M.C.B. Funding Information: M.B. is an employee of Diabetes Western Australia, but the organization had no influence on the interpretation or reporting of results beyond consumer group participation. M.B. is the recipient of a research fellowship from the Australian Diabetes Educator Association{\textendash}Diabetes Research Foundation, which has provided a researcher stipend to support Doctor of Philosophy Studies. ",

year = "2021",

month = oct,

doi = "10.1016/j.jcjd.2021.01.001",

language = "English",

volume = "45",

pages = "619--628",

journal = "Canadian Journal of Diabetes",

issn = "1499-2671",

publisher = "Elsevier",

number = "7",

}

Self-Management Group Education to Reduce Fear of Hypoglycemia as a Barrier to Physical Activity in Adults Living With Type 1 Diabetes: A Pilot Randomized Controlled Trial. / Brennan, Marian C.; Albrecht, Matthew A.; Brown, Janie A. et al.
In: Canadian Journal of Diabetes, Vol. 45, No. 7, 10.2021, p. 619-628.

Research output: Contribution to journal › Journal article › Research › peer-review

TY - JOUR

T1 - Self-Management Group Education to Reduce Fear of Hypoglycemia as a Barrier to Physical Activity in Adults Living With Type 1 Diabetes

T2 - A Pilot Randomized Controlled Trial

AU - Brennan, Marian C.

AU - Albrecht, Matthew A.

AU - Brown, Janie A.

AU - Leslie, Gavin D.

AU - Ntoumanis, Nikos

N1 - Funding Information: The authors thank the research participants and steering group members for volunteering their time and providing meaningful contributions throughout the project. We also thank Diabetes Western Australia for providing in-kind support to the project. This research article contributes toward a Doctor of Philosophy degree pursued by M.C.B. Funding Information: M.B. is an employee of Diabetes Western Australia, but the organization had no influence on the interpretation or reporting of results beyond consumer group participation. M.B. is the recipient of a research fellowship from the Australian Diabetes Educator Association–Diabetes Research Foundation, which has provided a researcher stipend to support Doctor of Philosophy Studies.

PY - 2021/10

Y1 - 2021/10

N2 - Objectives: The aim of this study was to evaluate the feasibility, acceptability and preliminary efficacy of a theory-driven group education intervention designed to reduce fear of hypoglycemia (FoH) as a barrier to physical activity (PA) in adults with type 1 diabetes (T1D). Methods: This study was a single-blinded, pilot randomized controlled trial of adults aged 18 to 65 years and living with T1D in Western Australia. Participants were randomized (1:1) to standard care or intervention with self-management education. Primary outcomes were feasibility and acceptability of the study procedures, and change to barriers to PA and FoH. Secondary outcomes were change to attitudes and intentions toward PA, self-reported participation in PA, self-efficacy, diabetes distress and well-being. To calculate effect sizes, we used a Bayesian comparison of the between-group difference scores (i.e. [scoret2 − scoret1]TREATMENT vs [scoret2 − scoret1]CONTROL). Results: We randomized 117 participants with T1D, 86 (74%) of whom provided baseline data and attended initial workshops. Of these participants, 81% attended the booster workshop 4 weeks later. They were 45±12 years of age, reported high levels of activity and had been living with T1D for 20±14 years. Small-to-moderate effect sizes [ESs] in favour of the intervention were observed at 12 weeks for overall barriers to PA (ES, −0.38; highest density interval, −0.92 to 0.17), self-efficacy for blood glucose management after PA (ES, 0.45; highest density interval, 0 to 0.91), diabetes distress (ES, −0.29; highest density interval, −0.77 to 0.15) and well-being (ES, 0.36; highest density interval, −0.12 to 0.8). Conclusions: Quantitative findings indicate study procedures were acceptable to participants and feasible to deliver. A future definitive trial is justified to replicate preliminary efficacy and to determine the utility of the intervention for improving PA participation.

AB - Objectives: The aim of this study was to evaluate the feasibility, acceptability and preliminary efficacy of a theory-driven group education intervention designed to reduce fear of hypoglycemia (FoH) as a barrier to physical activity (PA) in adults with type 1 diabetes (T1D). Methods: This study was a single-blinded, pilot randomized controlled trial of adults aged 18 to 65 years and living with T1D in Western Australia. Participants were randomized (1:1) to standard care or intervention with self-management education. Primary outcomes were feasibility and acceptability of the study procedures, and change to barriers to PA and FoH. Secondary outcomes were change to attitudes and intentions toward PA, self-reported participation in PA, self-efficacy, diabetes distress and well-being. To calculate effect sizes, we used a Bayesian comparison of the between-group difference scores (i.e. [scoret2 − scoret1]TREATMENT vs [scoret2 − scoret1]CONTROL). Results: We randomized 117 participants with T1D, 86 (74%) of whom provided baseline data and attended initial workshops. Of these participants, 81% attended the booster workshop 4 weeks later. They were 45±12 years of age, reported high levels of activity and had been living with T1D for 20±14 years. Small-to-moderate effect sizes [ESs] in favour of the intervention were observed at 12 weeks for overall barriers to PA (ES, −0.38; highest density interval, −0.92 to 0.17), self-efficacy for blood glucose management after PA (ES, 0.45; highest density interval, 0 to 0.91), diabetes distress (ES, −0.29; highest density interval, −0.77 to 0.15) and well-being (ES, 0.36; highest density interval, −0.12 to 0.8). Conclusions: Quantitative findings indicate study procedures were acceptable to participants and feasible to deliver. A future definitive trial is justified to replicate preliminary efficacy and to determine the utility of the intervention for improving PA participation.

KW - adults

KW - diabetes mellitus

KW - exercise

KW - fear of hypoglycemia

KW - health education

KW - self-management

KW - type 1

U2 - 10.1016/j.jcjd.2021.01.001

DO - 10.1016/j.jcjd.2021.01.001

M3 - Journal article

C2 - 33648863

AN - SCOPUS:85101645533

SN - 1499-2671

VL - 45

SP - 619

EP - 628

JO - Canadian Journal of Diabetes

JF - Canadian Journal of Diabetes

IS - 7

ER -

Self-Management Group Education to Reduce Fear of Hypoglycemia as a Barrier to Physical Activity in Adults Living With Type 1 Diabetes: A Pilot Randomized Controlled Trial

Abstract

Bibliographical note

Funding

Keywords

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