Parallel reductions in diabetes distress through distinct pathways: a mixed-methods study of two interventions in adolescents with type 1 diabetes.

OBJECTIVE: Adolescents with type 1 diabetes (T1D) frequently experience elevated diabetes distress, which is associated with poorer psychosocial and glycemic outcomes. Mindfulness-based intervention (MBI) and education programs may reduce distress through distinct mechanisms. This mixed-methods study examined adolescents' experiences of two group-based interventions to understand perceived benefits, mechanisms of change, and satisfaction in the context of diabetes distress trajectories. METHODS: Participants were N = 39 adolescents with T1D enrolled in a pilot randomized controlled trial comparing MBI to diabetes-focused health education. Adolescents completed the Problem Areas in Diabetes-Teen scale at baseline, post-intervention, and 3-month follow-up. Reliable Change Index criteria classified diabetes distress trajectories. Semi-structured post-intervention interviews (n = 37) were analyzed using reflexive thematic analysis. Quantitative and qualitative findings were integrated through joint display. RESULTS: Diabetes distress decreased from baseline to post-intervention (B = -11.01, SE = 2.87, p < .001) and remained lower at follow-up (B = -7.02, SE = 2.87, p = .017), with no group difference. Qualitative analyses identified three themes: (1) each intervention appeared to effectively target its respective core mechanism to reduce distress, (2) connecting with others with shared lived experiences was a powerful support for adolescents in both interventions, and (3) barriers to satisfaction centered on intervention content and group dynamics, and were more salient in MBI. CONCLUSIONS: MBI and diabetes-focused health education may reduce diabetes distress through distinct yet complementary mechanisms. Integrating adolescents' perspectives with outcome data underscores the importance of peer connection, engagement, and intervention tailoring to optimize psychosocial care for adolescents with T1D.