Teamwork, Targets, Technology, and Tight Control in Newly Diagnosed Pediatric T1D - 4T Study

Parent Diabetes Distress Scale (Parent-DDS):

The Parent-DDS is a 20-item questionnaire assessing diabetes-related distress experienced by parents of adolescents with type 1 diabetes. It includes four subscales: Personal Distress, Teen Management Distress, Parent/Teen Relationship Distress, and Healthcare Team Distress.

Each item is rated on a 6-point Likert scale ranging from 1 (Not a problem) to 6 (A very serious problem). Total and subscale scores are calculated as the mean of the completed item responses (sum of the item responses divided by the number of completed items), yielding possible scores ranging from 1.0 to 6.0 for both the total score and each subscale. Higher scores indicate greater diabetes-related parental distress (worse outcome). Mean item scores of 1.0-1.9 indicate "little or no distress", 2.0-2.9 indicate "moderate distress", and ≥3.0 indicate "high distress". Moderate or high distress may warrant clinical attention depending on the clinical context.

Diabetes Distress Scale-Youth (DDS-2) Youth completed the DDS-225 survey that evaluates if youth have been "feeling overwhelmed by demands of living with diabetes" or "failing with my diabetes routine" on a six-point Likert scale ("1: Not a problem" to "A very serious problem") in the last month. The response from each question was summed to create a score from 2 to 12, where higher scores are indicative of more symptoms of diabetes distress. The DDS-2 was selected for youth as it is an established screening measure for additional evaluation and to minimize survey burden.

This tool measures the benefits and burden of Continuous Glucose Monitor (CGM) device use, and is reported by youth participants who were 11 and older.

Continuous Glucose Monitoring Benefits Scale (BenCGM):

The BenCGM is an 8-item questionnaire assessing perceived benefits of continuous glucose monitoring (CGM).

Each item is rated on a 5-point Likert scale ranging from 1 (Strongly disagree) to 5 (Strongly agree). Item responses are summed to calculate a total score ranging from 8 to 40. Higher scores indicate greater perceived benefits of CGM (better outcome).

This tool measures the burden of Continuous Glucose Monitor (CGM) device use, and is reported by youth participants who were 11 and older.

Continuous Glucose Monitoring Burden Scale (BurCGM):

The BurCGM is an 8-item questionnaire assessing perceived burdens of continuous glucose monitoring (CGM).

Each item is rated on a 5-point Likert scale ranging from 1 (Strongly disagree) to 5 (Strongly agree). Item responses are summed to calculate a total score ranging from 8 to 40. Higher scores indicate greater perceived burdens of CGM (worse outcome).

This measure has questions on attitudes and use of various general technologies (e.g., smartphone) and diabetes devices, and is reported by participants.

Diabetes Technology Attitude Scale:

The Diabetes Technology Attitude Scale is a 5-item participant-reported questionnaire assessing attitudes toward diabetes-specific technology.

Each item is rated on a 5-point Likert scale to indicate agreement with the statement, ranging from 1 (Strongly disagree) to 5 (Strongly agree). Item responses are summed to calculate a total score ranging from 5 to 25. Higher scores indicate more positive attitudes toward diabetes technology (better outcome).

This measure is widely used to capture general and overall health and is reported by participants (youth).

PROMIS Pediatric Global Health (PGH-7):

The PROMIS Pediatric Global Health (PGH-7) is a 7-item participant-reported questionnaire that assesses youths' perceptions of their overall health, quality of life, physical health, and mental health.

Each item is rated on a 5-point Likert scale ranging from 1 (Poor) to 5 (Excellent). Item responses are summed to calculate a total score ranging from 7 to 35. Higher scores indicate better overall pediatric global health (better outcome).

Youth Physical Activity Questionnaire (Y-PAQ) is a measure used to determine overall physical activity in the last 7 days, and is reported by participants.

Score Range: 1 to 3. Interpretation: Higher scores indicate higher levels of physical activity, a better outcome.

International Physical Activity Questionnaire (IPAQ) asks about physical activity and sedentary behavior in the last 7 days, and is reported by participants (youth).

International Physical Activity Questionnaire (IPAQ): The IPAQ assesses self-reported physical activity during the previous 7 days, including vigorous-intensity activity, moderate-intensity activity, walking, and sitting. Total physical activity is reported as metabolic equivalent of task minutes per week (MET-minutes/week) and is calculated by weighting the reported duration and frequency of walking, moderate-intensity activity, and vigorous-intensity activity by their corresponding MET values (3.3, 4.0, and 8.0 METs, respectively) and summing these values. Sitting time is assessed separately and is not included in the total MET-minutes/week calculation. Higher MET-minutes/week indicate greater physical activity.

The Hypoglycemic Fear Survey in Youth (HFS-II) is a 25-item participant-reported questionnaire assessing fear of hypoglycemia in youth with type 1 diabetes. It includes a 10-item Behavior subscale and a 15-item Worry subscale. Each question was scored on a 5-point Likert scale ranging from 0 to 4:

0 = Never

1. = Rarely
2. = Sometimes
3. = Often
4. = Almost Always

For each participant, item ratings are summed to calculate the Behavior score (range: 0-40) and Worry score (range: 0-60). The Total score is calculated by summing the Behavior and Worry scores (range: 0-100). Higher scores on the Youth Behavior subscale indicate greater avoidance behaviors (worse outcome). Higher scores on the Youth Worry subscale indicate greater worry regarding hypoglycemia (worse outcome). Higher total scores indicate greater overall fear of hypoglycemia (worse outcome). The table reports the mean and standard deviation of participants' summed scores at baseline, 6 months, and 12 months.

The Hypoglycemic Fear Survey-Parent (HFS-P) is a 26-item parent-reported questionnaire assessing fear of hypoglycemia for their child with type 1 diabetes. It includes a 11-item Behavior subscale and a 15-item Worry subscale. Each question was scored on a 5-point Likert scale ranging from 0 to 4:

0 = Never

1. = Rarely
2. = Sometimes
3. = Often
4. = Almost Always

For each participant, item ratings are summed to calculate the Behavior score (range: 0-44) and Worry score (range: 0-60). The Total score is calculated by summing the Behavior and Worry scores (range: 0-104). Higher scores on the Parent Behavior subscale indicate greater avoidance/preventative behaviors (worse outcome). Higher scores on the Parent Worry subscale indicate greater worry regarding hypoglycemia (worse outcome). Higher total scores indicate greater overall fear of hypoglycemia (worse outcome). Table reports the mean and standard deviation of participants' summed scores at baseline, 6 months, and 12 months.

Self-Efficacy for Exercise (SEE) Scale measures how confident people are in their ability to overcome barriers to exercise.

Total scale is calculated by summing the responses to each question. The scale has a range of total scores from 0-90. A higher score indicates higher self-efficacy for exercise.

The number of participants attending at least one telehealth exercise education session.