Document Type

Article

Publication Date

11-3-2026

Identifier

DOI: 10.2196/95475; PMCID: PMC13730211

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.

Journal Title

JMIR Pediatr Parent

Volume

9

First Page

95475

Last Page

95475

PubMed ID

42976196

Keywords

anxiety; hypoglycemia fear; parenting; pediatrics; type 1 diabetes

Comments

Grants and funding

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Pediatrics and Parenting, is properly cited. The complete bibliographic information, a link to the original publication on https://pediatrics.jmir.org, as well as this copyright and license information must be included.

Publisher's Link: https://pediatrics.jmir.org/2026/1/e95475/

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