Parent Anxiety and Response to a Telehealth Intervention for Hypoglycemia Fear: Secondary Analysis of a Randomized Trial
5 affiliations
- 1Center for Healthcare Delivery Science, Nemours Children's Clinic, 807 Children's Way, Jacksonville, FL, 32207, United States, 1 904-697-3595, 1 904-697-3425
- 2Center for Healthcare Delivery Science, Nemours Children's Clinic, Orlando, FL, United States
- 3Division of Psychology, Nemours Children's Clinic, Jacksonville, FL, United States
- 4Division of Endocrinology, Children's Mercy Hospital, Kansas City, MO, United States
- 5Center for Diabetes Technology, University of Virginia, Charlottesville, VA, United States
Abstract
Background: Parents of young children with type 1 diabetes (T1D) frequently report fear of hypoglycemia (FH), which can impact their diabetes management. REDCHiP (Reducing Emotional Distress for Childhood Hypoglycemia in Parents) is a telehealth-delivered cognitive behavioral intervention shown to reduce FH, but less is known about which parents benefit most.
Objective: This secondary analysis examined whether pretreatment parent anxiety moderated REDCHiP’s effects and explored responder patterns by intervention arm and pretreatment anxiety.
Methods: This was a secondary analysis of a large, randomized clinical trial comparing REDCHiP to an attention control condition (ATTN). We assessed outcomes before treatment (time 1) and 3 months after treatment (time 3). Our primary outcome was parental FH at time 3, adjusted for time 1 FH. The original trial used validated measures of parent FH and general anxiety. We evaluated parent anxiety at time 1 as both a categorical variable (clinically elevated or not) and a continuous variable (centered). We defined responders as parents achieving a reduction of ≥0.5 SDs in FH from time 1 to time 3. An analysis of covariance tested the treatment arm by anxiety interaction, with sensitivity analyses modeling anxiety continuously.
Results: There was no significant treatment arm by anxiety interaction when modeling parent anxiety as either a categorical or continuous variable (P>.05). However, exploratory analyses found that the adjusted mean time 3 FH was numerically lower among REDCHiP parents than ATTN parents with clinically elevated anxiety. Among parents with elevated anxiety, 78.6% (22/28) of REDCHiP parents met our responder criterion compared with 47.4% (9/19) of ATTN parents. Among parents with elevated anxiety, the adjusted odds of meeting the responder criterion were higher for REDCHiP than ATTN parents (odds ratio 6.35, 95% CI 1.47‐29.00).
Conclusions: While time 1 parent anxiety did not significantly moderate treatment response, exploratory analyses suggested a potentially meaningful pattern among parents with clinically elevated anxiety. As telehealth-delivered behavioral interventions expand in pediatric type 1 diabetes care, secondary analyses of participant characteristics may help guide targeted implementation and enhance treatment benefit.
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BibTeX
@article{patton2026parent,
title = {{Parent Anxiety and Response to a Telehealth Intervention for Hypoglycemia Fear: Secondary Analysis of a Randomized Trial}},
author = {Susana R Patton and Alexandra Monzon and Nicole Kahhan and Jacob Redel and Kimberly Driscoll},
journal = {JMIR Pediatrics and Parenting},
year = {2026},
month = nov,
doi = {10.2196/95475},
url = {https://doi.org/10.2196/95475},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Parent Anxiety and Response to a Telehealth Intervention for Hypoglycemia Fear: Secondary Analysis of a Randomized Trial
AU - Susana R Patton
AU - Alexandra Monzon
AU - Nicole Kahhan
AU - Jacob Redel
AU - Kimberly Driscoll
PY - 2026
DA - 2026/11/03
JO - JMIR Pediatrics and Parenting
DO - 10.2196/95475
UR - https://doi.org/10.2196/95475
AB - Background: Parents of young children with type 1 diabetes (T1D) frequently report fear of hypoglycemia (FH), which can impact their diabetes management. REDCHiP (Reducing Emotional Distress for Childhood Hypoglycemia in Parents) is a telehealth-delivered cognitive behavioral intervention shown to reduce FH, but less is known about which parents benefit most. Objective: This secondary analysis examined whether pretreatment parent anxiety moderated REDCHiP’s effects and explored responder patterns by intervention arm and pretreatment anxiety. Methods: This was a secondary analysis of a large, randomized clinical trial comparing REDCHiP to an attention control condition (ATTN). We assessed outcomes before treatment (time 1) and 3 months after treatment (time 3). Our primary outcome was parental FH at time 3, adjusted for time 1 FH. The original trial used validated measures of parent FH and general anxiety. We evaluated parent anxiety at time 1 as both a categorical variable (clinically elevated or not) and a continuous variable (centered). We defined responders as parents achieving a reduction of ≥0.5 SDs in FH from time 1 to time 3. An analysis of covariance tested the treatment arm by anxiety interaction, with sensitivity analyses modeling anxiety continuously. Results: There was no significant treatment arm by anxiety interaction when modeling parent anxiety as either a categorical or continuous variable (P>.05). However, exploratory analyses found that the adjusted mean time 3 FH was numerically lower among REDCHiP parents than ATTN parents with clinically elevated anxiety. Among parents with elevated anxiety, 78.6% (22/28) of REDCHiP parents met our responder criterion compared with 47.4% (9/19) of ATTN parents. Among parents with elevated anxiety, the adjusted odds of meeting the responder criterion were higher for REDCHiP than ATTN parents (odds ratio 6.35, 95% CI 1.47‐29.00). Conclusions: While time 1 parent anxiety did not significantly moderate treatment response, exploratory analyses suggested a potentially meaningful pattern among parents with clinically elevated anxiety. As telehealth-delivered behavioral interventions expand in pediatric type 1 diabetes care, secondary analyses of participant characteristics may help guide targeted implementation and enhance treatment benefit.
SN - 2561-6722
ER -