# Psychosocial support for adult-onset type 1 diabetes: the living with and adapting to type 1 diabetes programme - a cross-national feasibility study

## TL;DR

This study explores a program called LADDER to help adults with type 1 diabetes manage psychosocial challenges, but found it difficult to conduct a controlled trial due to low recruitment and other issues.

## Contribution

The study introduces a novel psychosocial intervention for adult-onset type 1 diabetes and evaluates its feasibility in cross-national settings.

## Key findings

- Low recruitment and questionnaire response rates hindered quantitative analysis of the LADDER program.
- Qualitative feedback suggested the program supports psychosocial adaptation through reflection and peer support.
- A realist evaluation approach is recommended for future larger studies on the LADDER interventions.

## Abstract

Psychosocial challenges related to adult-onset type 1 diabetes are not systematically addressed in routine diabetes care. The Living with and Adapting to DiabetEs pRogramme (LADDER) was developed to support psychosocial adaptation to diabetes through two distinct interventions: 1) one-to-one consultations, and 2) group sessions. The LADDER interventions were tested in Denmark and the UK to evaluate the feasibility of 1) the research processes; 2) the delivery of the intervention; 3) collection of psychosocial and clinical outcomes and perceived benefits of participation; and to 4) identify key areas for improvement of the interventions.

We aimed to examine the feasibility of the one-to-one consultations via a controlled design with either non-random (Denmark) or random allocation (UK) to intervention or usual care and the group sessions via a wait-list randomised trial (UK). Psychosocial outcomes were collected through questionnaires, and clinical outcomes were obtained from electronic records. A concurrent process evaluation was conducted through interviews with participants and healthcare professionals.

The recruitment target was reached in Denmark. Due to a lower-than-expected number of participants, randomisation was abandoned in the UK. Questionnaire response rates were low, and clinical data were difficult to obtain. Due to uncontrolled study designs, small sample sizes, and high questionnaire attrition, quantitative comparisons between intervention and control groups were not feasible. Qualitative findings suggested that the LADDER interventions may support psychosocial adaptation by facilitating reflection, articulation of concerns, and shared understanding within supportive clinical and peer contexts.

Conducting an evaluation of the LADDER interventions through a controlled study was not feasible, likely due to small study populations at each site, combined with changes in clinical working following COVID-19. We suggest using a realist evaluation approach for a future larger study to explore what aspects of LADDER works, for whom and in which contexts.