“Keeping in Touch” to empower youth with type 1 diabetes in the transition to adult care

For teens with chronic medical conditions such as type 1 diabetes, turning 18 means a transition from pediatric to adult care. Once in adult care, teens are responsible for booking medical appointments, discussing treatment options with doctors, managing their medication, and more.

Wanting to help teens and young adults with type 1 diabetes navigate this new reality, Dr. Rayzel Shulman at The Hospital for Sick Children joined forces with Dr. Joseph Cafazzo at the University Health Network’s Centre of Digital Therapeutics, health care professionals, and youth with type 1 diabetes like Marley Greenberg, who was 19 when she joined the team. Together, they designed Keeping in Touch, a program using text messages to support teens during the transition to adult care.

But why text messages? “Previous research has shown that adolescents and young adults use text messaging as their preferred communications channel, as opposed to telephones, emails, or apps,” explains Dr. Shulman. Patients involved in the project also confirmed that texting was the best way to engage and follow up with this age group.

Keeping in Touch sends teens reminders about upcoming appointments, helping them coordinate their care more independently. This also means better care coordination at the clinic level thanks to fewer missed appointments.

The program also includes learning modules based on a database of trusted resources. Having grown up with type 1 diabetes, Marley knows that it is not easy for teens and young adults to find reliable information about type 1 diabetes. “There is so much misinformation on the Internet, but youth may not always have the time or energy to fact check or to get in touch with their diabetes clinic for immediate advice,” she says.

Looking for tips before hitting the gym? What should you do after a night out with friends? Is it safe to drive with low blood sugar? What should you know about sex and type 1 diabetes? Keeping in Touch has got you covered!

And if teens still have questions, they can type them in an artificial intelligence chatbot. The research team trained a language model to share reliable answers in an age-appropriate style, based on topics of interest identified by youth. This means short text messages with slangs, acronyms, and emojis, all backed up by trusted sources.

Dr. Shulman and team are now testing the program in a randomized controlled trial with 234 youth across six clinics in Ontario and Quebec. By supporting care coordination and promoting health education, Keeping in Touch promises to empower many teens with type 1 diabetes during the transition to adult care in Canada.

At a glance

Issue

Transitioning from pediatric to adult care may be an overwhelming experience for teens living with chronic medical conditions like type 1 diabetes, who now must manage their own care.

Research

Researchers, health professionals, and teens with type 1 diabetes developed a text message-based system to promote health education, coordinate care, and keep teens with type 1 diabetes from falling through the cracks in the health system.