Currently accepted at: JMIR Pediatrics and Parenting
Date Submitted: Mar 17, 2026
Date Accepted: Oct 2, 2026
This paper has been accepted and is currently in production.
It will appear shortly on 10.2196/95475
The final accepted version (not copyedited yet) is in this tab.
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Moderating Role of Parent Anxiety in a Telehealth Intervention for Hypoglycemia Fear: Secondary Analysis of a Randomized Trial
ABSTRACT
Background:
Parents of young children with type 1 diabetes (T1D) frequently report hypoglycemia fear (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 pre-treatment parent anxiety moderated REDCHiP’s effects and explored responder patterns within the intervention arm.
Objective:
This secondary analysis examined whether pre-treatment parent anxiety moderated REDCHiP’s effects and explored responder patterns within the intervention arm.
Methods:
This is a secondary analysis of a large, randomized clinical trial comparing REDCHiP to an attention control (ATTN). We assessed outcomes at pre-treatment (Time 1) and three months post-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 achieving ≥0.5SD reduction in FH from Time 1 to 3. A univariate ANOVA tested the treatment arm X anxiety interaction, with sensitivity analyses modeling anxiety continuously. Within REDCHiP, we examined demographic correlates of treatment response.
Results:
There was a statistical trend for the treatment arm X anxiety interaction (p=0.057). Among parents with clinically elevated anxiety, REDCHiP participants showed significantly lower adjusted FH at Time 3 than ATTN participants (mean difference= -6.78; p=.01). Continuous anxiety did not significantly moderate treatment effects (p=.22), though REDCHiP retained significant benefit at mean anxiety levels (p=.027). Within REDCHiP, 78.6% of parents with elevated anxiety met responder criteria.
Conclusions:
Parents with clinically elevated anxiety demonstrated the greatest reductions in FH. As telehealth-delivered behavioral interventions expand in pediatric diabetes care, secondary analyses of participant characteristics may help guide targeted implementation and enhance treatment benefit. Clinical Trial: ClinicalTrials.gov NCT3914547
Citation
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