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Improving outcomes for young adults with type 1 diabetes in Ireland: the D1 now feasibility and cluster randomised pilot study

Young adults with type 1 diabetes often experience poor outcomes. Reasons for this include poor knowledge and self-management skills, high levels of psychosocial distress, poor clinic attendance, poor adherence with treatment recommendations and engaging in high risk behaviours.
Since 2014 our multi-disciplinary research team (including young adults with type 1 diabetes) has been working to develop a new intervention to improve outcomes for young adults with type 1 diabetes. This work has been informed by the Medical Research Council guidelines for developing and evaluating complex interventions and the Behaviour Change Wheel for characterising and designing behaviour change interventions.
Through our systematic review, our qualitative research with key stakeholders and feedback from our Young Adult Panel, three areas have been identified as important for self-management: (a) the young adults introduction to the adult diabetes services, (b) attendance at clinic appointments and informal contact between appointments and (c) building relationships between young adults and service providers. An Expert Panel (including young adults with type 1 diabetes) identified three components to facilitate improvement in these areas: (a) a key worker to introduce the young adult to the diabetes service, act as an advocate and conduct a needs and priorities assessment; (b) an online Young Adult Service Portal to facilitate stronger connections between staff and young adults and (c) an agenda setting tool to facilitate collaborative decision making and goal setting to optimise diabetes management. These three components will make up our D1 now intervention.
In the proposed work we will further refine theD1 nowintervention before testing itsfeasibility and acceptability in a multi-centre, cluster randomised pilot in advance of a definitive trial.
The proposed work will be delivered through 4 work packages:
1. Developing, modelling and refining theD1 nowintervention
2. Testing the feasibility of theD1 nowintervention
3. Undertaking a cluster randomised pilot of theD1 nowintervention
4. Continuing to listen to the patient voice in our research through the formation of Young Adult Panels
The study team will use the findings from the feasibility and pilot phases to publish a protocol for a future definitive trial.