Exploring Treatment Mechanisms of the Resilient, Empowered, Active Living-Telehealth (REAL-T) Intervention

Background Type 1 diabetes (T1D) is a lifelong condition affecting all aspects of life. Although Lifestyle Redesign ® interventions support diabetes self-management, little is known about which intervention exposure and engagement indicators are associated with changes in glucose outcomes, quality of life (QoL), and diabetes-related distress. Purpose To explore intervention exposure and engagement indicators associated with pre–post changes in glucose, QoL, and diabetes-related distress among individuals receiving the REAL-Telehealth (REAL-T) intervention. Method Using an as-treated analytic approach, data from the REAL-T randomized controlled trial were analyzed. Outcomes included changes in A1c, glycemic risk index (GRI), QoL, and diabetes-related distress. Intervention factors included the number of goals, the number of occupational therapy sessions, goal attainment, and changes in occupational performance. Hierarchical regression analyses were conducted. Findings In models adjusted for baseline values and relevant demographic covariates, baseline A1c and a higher proportion of goals met were associated with greater reductions in A1c. Higher baseline GRI, non-Hispanic White race/ethnicity, a higher proportion of goals met, and greater improvements in occupational performance were associated with better improvements in GRI scores. Changes in QoL and diabetes-related distress were primarily explained by baseline levels, with limited additional contribution from intervention exposure and engagement indicators. Conclusions This exploratory, process-focused analysis identified a limited number of intervention exposure and engagement indicators associated with outcome changes. Findings highlight the importance of process-level analyses to better understand how Lifestyle Redesign ® interventions operate in real-world contexts and to inform future intervention refinement.