ACT1VATE: Addressing Emotional Distress to Improve Outcomes Among Diverse Adults With Type 1 Diabetes

NCT ID: NCT04933851

Last Updated: 2025-07-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE2

Total Enrollment

250 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-10-25

Study Completion Date

2027-03-31

Brief Summary

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This research will compare a psychological intervention ("ACT1VATE") versus diabetes self-management education and support (DSME/S; usual care) in improving clinical, behavioral, psychosocial, process, and cost outcomes among adults with poorly controlled type 1 diabetes (T1D) who are experiencing significant diabetes-related emotional distress and poor glycemic control in a real world, healthcare environment.

Detailed Description

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This randomized controlled trial will compare a telemedicine psychological intervention specifically designed to address diabetes distress ("ACT1VATE") versus traditional diabetes self-management education and support (DSME/S; usual care) in improving glycemic control among N=250 adults with type 1 diabetes (T1D), glycosylated hemoglobin (HbA1c) between 7.5% - 12.5% in the last 90 days, and significant diabetes distress. Capitalizing on existing and real-world processes, the electronic health record (EHR) will be used to identify eligible patients and examine primary outcomes. Participants randomized to the usual care group will be offered standard, 1:1 DSME/S delivered by a Certified Diabetes Care and Education Specialist via telemedicine format. Participants randomized to the ACT1VATE group will be offered 5 group-therapy telemedicine sessions delivered by a Behavioral Health Provider who is an integrated member of the diabetes care team. ACT1VATE is grounded in Acceptance and Commitment Therapy (ACT), which has been delivered effectively in clinics via brief format; implemented via phone and other modalities; and adapted for a wide range of chronic conditions. The primary clinical outcome, HbA1c, assessed as part of quarterly standard-of-care medical visits will be extracted from the EHR over 12 months. Changes in patient-reported behavioral (diabetes self-care) and psychosocial (emotional well-being, quality of life) outcomes will be evaluated via online surveys at baseline, month 6, and month 12. A thorough process evaluation will be conducted to establish reach, acceptability/feasibility, adoption/maintenance, and fidelity of the intervention and will integrate patient and provider perspectives. Cost-effectiveness will also be examined from the health system perspective. By maximizing integration with routine medical care for T1D in a real world, healthcare environment, results will be highly generalizable and hold great potential to inform the future of care for adults living with T1D.

Conditions

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Type 1 Diabetes

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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ACT1VATE

Participants assigned to the intervention group will be offered a psychological intervention specifically designed to address diabetes-related emotional distress.

Group Type EXPERIMENTAL

ACT1VATE

Intervention Type BEHAVIORAL

ACT1VATE, informed by Acceptance and Commitment Therapy (ACT), will consist of five, 90-minute group-based telemedicine therapy sessions delivered by a Behavioral Health Provider.

DSME/S (usual care)

Participants randomized to the usual care group will be offered standard diabetes self-management education and support (DSME/S).

Group Type ACTIVE_COMPARATOR

DSME/S

Intervention Type BEHAVIORAL

Diabetes self-management education and support (DSME/S) will be delivered by a Certified Diabetes Care and Education Specialist via one-on-one telemedicine format.

Interventions

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ACT1VATE

ACT1VATE, informed by Acceptance and Commitment Therapy (ACT), will consist of five, 90-minute group-based telemedicine therapy sessions delivered by a Behavioral Health Provider.

Intervention Type BEHAVIORAL

DSME/S

Diabetes self-management education and support (DSME/S) will be delivered by a Certified Diabetes Care and Education Specialist via one-on-one telemedicine format.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Spanish or English-speaking
* Type 1 diabetes
* Glycosylated Hemoglobin (HbA1c) 7.5% - 12.5% in last 90 days
* Screen positive for diabetes distress

Exclusion Criteria

* Severe medical or psychological conditions that would interfere with participation based on the opinion of a provider
* Plans to move out of the San Diego area in the next 12 months
* Lack of technology capability required to complete online surveys and telemedicine visit
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

NIH

Sponsor Role collaborator

Scripps Whittier Diabetes Institute

OTHER

Sponsor Role lead

Responsible Party

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Athena Philis-Tsimikas

Corporate Vice President

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Addie Fortmann, PhD

Role: PRINCIPAL_INVESTIGATOR

Scripps Whittier Diabetes Institute

Athena Philis-Tsimikas, MD

Role: PRINCIPAL_INVESTIGATOR

Scripps Whittier Diabetes Institute

Locations

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Scripps Whittier Diabetes Institute

San Diego, California, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Haley Sandoval

Role: CONTACT

970-497-6701

Addie Fortmann, PhD

Role: CONTACT

858-922-2276

Facility Contacts

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Addie Fortmann, PhD

Role: primary

858-922-2276

References

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Soriano EC, Fortmann AL, Guzman SJ, Sandoval H, Spierling Bagsic SR, Bastian A, Antrim M, Chichmarenko M, Philis-Tsimikas A. Addressing emotional distress to improve outcomes in adults with type 1 diabetes: Protocol for ACT1VATE randomized controlled trial. Contemp Clin Trials. 2024 Nov;146:107687. doi: 10.1016/j.cct.2024.107687. Epub 2024 Sep 13.

Reference Type DERIVED
PMID: 39265782 (View on PubMed)

Other Identifiers

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R01DK127491

Identifier Type: NIH

Identifier Source: secondary_id

View Link

1R01DK127491

Identifier Type: NIH

Identifier Source: org_study_id

View Link

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