Facilitating the Virtual Exercise Games for Youth with T1D (ExerT1D) Peer Intervention: Protocol Development and Feasibility (2024)


Background Barriers to moderate-to-vigorous physical activity (MVPA) for adolescents with type 1 diabetes (T1D) include physiology, transition to autonomy, and diabetes-specific stigma. Opportunities for T1D peer activities with T1D role model support are limited. To address this need, our single-arm pilot study tested the Home-based Virtual Activity Program for Youth with T1D (HAP-V-T1D) for feasibility.

Methods Participants (n=15) were mean age 15.6 [SD 1.5] years, 7 non-Hispanic white, 6 female, 2 non-binary, mean A1c 8.9%±2.2%. The program included an MVPA videogame, physician-led education regarding managing T1D around MVPA, objective habitual MVPA goal-setting , and T1D management skills guided by young adult instructors living with T1D.

Results For feasibility, 13/15 participants attended 10/12 sessions. Participants’ perceptions of the program, comfort, instructors, and group cohesion were rated high/very high (4.2±0.5 to 4.8±0.3 out of 5).

Motivation for the videogame was also high (4.1±0.4 out of 5). Instructor-adolescent interactions related to building T1D management skills were rated as excellent for 78% of sessions. Similarly, sharing knowledge and experiences were rated as excellent for 68% of sessions. However, adolescent-adolescent interactions were poor (communication 29% excellent, peer interactions 8% excellent). The most reported barriers to participation were negative mood and oversleeping. No participants experienced diabetic ketoacidosis, severe hypoglycemia, or injuries during the study period. Compared to baseline, glycemic metrics appeared to decrease during and post intervention (d= -0.72, -1.12).

Conclusion HAP-V-T1D facilitated unprecedented T1D peer support achievements by engaging diverse youth with T1D in an MVPA program led by T1D role models. Larger studies are needed to assess if this intervention can improve glycemic measures and reduce diabetes-specific stigma.

Competing Interest Statement

G.I.A. has in the last 3 years received grant support (to his institution) from the Patterson Trust, American Heart Association, National Institutes of Health, and Veterans Health Administration. He has also received professional services from Fitscript and Calm, on projects separate from the present study. S.N. receives grant support (to her institution) from the National Institutes of Health. C.T. is a consultant for Calm. M.S. is employed as a senior product manager by Abbott Laboratories and receives restricted stock units. S.A.W. currently receives grant support (to his institution) from Abbott Laboratories and the National Institutes of Health. In the last 3 years he has received honoraria for serving as a speaker for Abbott and Dexcom and as a consultant for Zealand Pharma. The Yale Childrens Diabetes Center receives free CGM supplies through the Abbott Laboratories clinical sample program, which are distributed to patients including some who participated in this study. L.M.N. receives funding for research from the National Institutes of Health and Medtronic Diabetes. She is also a consultant for Medtronic, WebMD, and Calm. The authors attest that the Patterson Trust, American Heart Association, National Institutes of Health, Veterans Health Administration, Fitscript, Calm, Abbott Laboratories, Dexcom, Zealand Pharma, Medtronic, and WebMD had no influence on the design of this study or its outcomes. The authors conducted the research outside of their responsibilities and affiliations with these entities.

Clinical Trial


Funding Statement

The study and G.I.A. were supported by American Heart Association Grant #852679 (G.I.A., 2021 to 2024) and a Robert E. Leet and Clara Guthrie Patterson Trust Mentored Research Award, Bank of America, N.A., Trustee. G.I.A. and L.M.N. were supported by the National Institute of Diabetes, Digestive, and Kidney Diseases of the National Institutes of Health under mentored research scientist development awards (K01DK129441, K23DK128560). The study was further supported by the National Institutes of Health under the Yale Diabetes Research Center (P30DK045735). None of these entities were involved in the study design, data collection, data analysis, manuscript writing, editing, approval, or decision to publish.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.


The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

IRB of Yale University gave ethical approval for this work.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.


I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).


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Facilitating the Virtual Exercise Games for Youth with T1D (ExerT1D) Peer Intervention: Protocol Development and Feasibility (2024)
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