Sustained Psychosocial Benefits of Telehealth Occupational Therapy for Young Adults With Type 1 Diabetes: Long-Term Follow-Up of the Resilient, Empowered, Active Living-Telehealth (REAL-T) Randomized Controlled Trial

PURPOSE: The purpose of this study was to examine 12-month outcomes of the Resilient, Empowered, Active Living-Telehealth (REAL-T) intervention for young adults with diabetes. METHODS: Young adults ages 18 to 30 years with type 1 diabetes ≥1 year and A1C ≥7.5% (≥58 mmol/mol) were randomized 1:1 to REAL-T (6 months of telehealth occupational therapy) or usual care. Continuous glucose monitor metrics, diabetes distress, and diabetes-related quality of life (DQoL) were assessed at baseline, 6, and 12 months, while A1C and hypothesized mediators were assessed quarterly. Linear mixed-effects models estimated longitudinal treatment effects. RESULTS: Of 209 randomized participants, 171 (82%) contributed 12-month data. No significant between-group differences were observed for glycemia. REAL-T participants showed greater improvements in emotional distress and diabetes self-efficacy than control group participants. Per protocol analyses excluding untreated participants yielded stronger effects, with significantly improved DQoL and regimen distress. CONCLUSIONS: A telehealth occupational therapy intervention produced durable improvements in emotional distress and self-efficacy over 12 months, supporting psychosocial outcomes as central treatment targets in young adults with type 1 diabetes.