Abstract
Type 1 diabetes (T1D) is a complex chronic condition requiring active, intensive daily self-management and decision-making. For young adults (18-29 years), these burdensome cognitive demands can contribute to future health complications, including a high prevalence of mental health challenges such as anxiety, depression, eating disorders, and diabetes distress, defined as a range of emotional responses to both living with and managing diabetes, including fear of hypoglycemia. Symptoms of these mental health challenges can contribute to impaired diabetes self-management, suboptimal glycemic management, and additional diabetes complications that impact quality of life. Despite this prevalence, mental health challenges often go unnoticed, and even when recognized, outside of a small number of specialized centres, there is limited access to healthcare solutions where both physical and mental health needs are met for this population.
The 4Cs, collaboration, communication, complementarity, and competence, have been established as essential attributes of the biopsychosocial provider within team-based, collaborative care models. A reflection on these 4Cs reveals an important missing element in day-to-day healthcare – compassion. Combining knowledge about suffering with efforts to alleviate it, compassion is expressed and experienced through connection where bonds that foster understanding, trust, and self-determination are forged.
Recognizing the need to address the complexity of living with both T1D and mental health challenges for young adults, and to deliver compassion in this care, our team co-designed and tested an integrated and relationship-driven model of care: Technology-Enabled Collaborative Care for young adults living with T1D and Diabetes distress (TECC-T1D3). In this mixed methods trial, a health coach, supported by an interdisciplinary virtual care team, built on individual strengths and promoted self-efficacy and hope to advance health, wellbeing, and address inequities in 30 young adults living with T1D. Adapting proven approaches and strategies, and utilizing existing technology, TECC-T1D3 explored compassion as both a process, the acts of connection that technology enhanced and enabled, and an outcome, the impact of these acts. Findings from this work demonstrate that TECC-T1D3 facilitates meaningful connections, including relationships that enhanced access to and receipt of compassionate care, and care for and by each other within supportive peer community, resulting in enhanced care of themselves.