Young adulthood is a challenging life stage for many with T1D; only 17% of 18-25 year olds and 30% of 26-30 year olds attain recommended HbA1c targets, and only 2% consistently perform diabetes self-care in accordance with national guidelines. To address these issues, our research team developed the REAL (Resilient, Empowered, Active Living) diabetes intervention, an individually tailored occupational therapy intervention focused on incorporating diabetes self-care into participants’ daily habits and routines, and evaluated its efficacy in a randomized controlled trial (n=81).
This study is investigating the efficacy of REAL as delivered via telehealth (REAL-T), an efficient and broadly disseminable care delivery model. The results of this study will inform clinical practice through providing evidence regarding the potential of REAL-T to improve health and quality of life among young adults with T1D both immediately following the intervention and over the long term. Furthermore, it will investigate the mediating mechanisms of REAL-T to better understand how the intervention attains its observed effects.
Journal Articles
Pyatak, E. A., Lee, P.-J., Nnoli, N. D., Mo, Y., Khurana, A., Ali, A., Fox, D. S., Sideris, J., Diaz, J., Granados, G., Blanchard, J., Lee, E. S., & Raymond, J. K. (2025). Telehealth occupational therapy improves psychosocial well-being but not glycemia among young adults with type 1 diabetes: The Resilient, Empowered, Active Living-Telehealth (REAL-T) randomized controlled trial. Diabetes Research and Clinical Practice, 221, 112005. https://doi.org/10.1016/j.diabres.2025.112005 Show abstract
Background.
Young adults with type 1 diabetes mellitus often face challenges managing their condition, leading to elevated glucose and heightened psychosocial distress. Diabetes care traditionally focuses on biomedical outcomes, with less emphasis on well-being. Occupational therapy offers a holistic approach to managing diabetes by integrating changes to daily habits and routines and psychosocial support.
Methods.
This randomized controlled trial involved participants aged 18–30 with HbA1c ≥ 7.5 % (≥58 mmol/mol). Participants received either telehealth occupational therapy or usual care. The intervention addressed diabetes management, daily habits and routines, and emotional well-being. Data collected at baseline, 3 months, and 6 months included HbA1c, continuous glucose monitoring metrics, and psychosocial outcomes. Analyses employed intent-to-treat principles, using ANCOVA to evaluate between-group differences.
Results.
Participants (n = 209) were 24.3 (±3.7) years old, 59.8 % female, 44.5 % non-Hispanic White, and 47.4 % publicly insured. No significant differences were found in glycemic outcomes. Intervention participants had improved diabetes-related quality of life (DQoL; least-squares [LS] mean 0.67, 95 % CI 0.02 to 1.32, p = 0.045) and reduced diabetes distress (LS-mean −0.36, CI −0.65 to −0.07, p = 0.01).
Conclusion.
Generalizability may be impacted by external factors related to COVID-19. The findings suggest occupational therapy may be beneficial for young adults experiencing diabetes-related distress and poor DQoL.
Pyatak, E. A., Ali, A., Khurana, A. R., Lee, P.-J., Sideris, J., Fox, S., Díaz, J., Granados, G., Blanchard, J., McGuire, R., Salazar Plascencia, E., Salcedo-Rodriguez, E., Flores-Garcia, J., Linderman, M., Taylor, E. E., Tapia, V., Nnoli, N., Sequeira, P. A., Freeby, M. J., & Raymond, J. K. (2023). Research design and baseline participant characteristics of the Resilient, Empowered, Active Living with Diabetes - Telehealth (REAL-T) Study: A randomized controlled trial for young adults with type. Contemporary Clinical Trials, 135, 107386. https://doi.org/10.1016/j.cct.2023.107386 Show abstract
Background. Type 1 diabetes (T1D) is a chronic condition affecting nearly 1.9 million people in the United States. Young adults (YAs) with T1D face unique challenges in managing their condition, experiencing poorer health and well-being than other age groups. The current study is evaluating the Resilient, Empowered, Active Living (REAL) intervention, previously shown to improve glucose levels and quality of life among YAs with diabetes, using telehealth delivery (REAL-T) to expand reach and accessibility. This paper reports on the methodology and baseline participant characteristics of the REAL-T study.
Methods. REAL-T is a two-arm randomized controlled trial that recruited 18–30 year olds with T1D via clinics and social media advertising. Data collection, which was adapted to be fully remote due to COVID-19, occurs every three months for one year. Participants receive either usual care or a 6-month telehealth occupational therapy intervention. The primary outcome is glycated hemoglobin (A1c); secondary outcomes include diabetes distress, quality of life, and continuous glucose monitor-derived measures.
Results. The study enrolled a diverse sample of 209 YAs with T1D. Analysis of baseline data indicates equivalence between the intervention and control groups. Study participants have notably higher diabetes distress and poorer mental well-being than similar populations.
Conclusion. The REAL-T study successfully adapted to remote implementation during the COVID-19 pandemic. By examining long-term outcomes, mediating pathways, and cost-effectiveness, the study will contribute knowledge of the impact of tailored interventions for YAs with T1D, designed to reduce disparities and improve health and well-being in this population.
Conference Presentations/Proceedings
Taylor, E., Abercrombie, J., Firestone, A., Ali, A., Khurana, A., & Kim, J. (2021). The impact of social media on COVID-era recruitment for the REAL-T study [Paper presentation]. USC Chan Occupational Science Symposium.
